Provider Demographics
NPI:1851660690
Name:PREGENZER, MARK WILLIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:PREGENZER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:757 WESTWOOD PLZ
Mailing Address - Street 2:ROOM B524
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7423
Mailing Address - Country:US
Mailing Address - Phone:310-267-8522
Mailing Address - Fax:310-267-3652
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:ROOM B524
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7423
Practice Address - Country:US
Practice Address - Phone:310-267-8522
Practice Address - Fax:310-267-3652
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 59690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist