Provider Demographics
NPI:1851669691
Name:TRILLANA, MYRNA YU (PHAMACIST)
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:YU
Last Name:TRILLANA
Suffix:
Gender:F
Credentials:PHAMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S. EL CIELO RD APT 85
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7913
Mailing Address - Country:US
Mailing Address - Phone:760-969-3703
Mailing Address - Fax:
Practice Address - Street 1:33975 DATE PALM DRIVE
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-4736
Practice Address - Country:US
Practice Address - Phone:760-202-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist