Provider Demographics
NPI:1922422039
Name:DEGUZMAN, EDWIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 OLYMPIC PKWY
Mailing Address - Street 2:SUITE 1006; #144
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1359
Mailing Address - Country:US
Mailing Address - Phone:303-667-2126
Mailing Address - Fax:
Practice Address - Street 1:748 C ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5308
Practice Address - Country:US
Practice Address - Phone:619-878-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist