Provider Demographics
NPI:1023390408
Name:MUPAS, OLIVIA PHAM (PHARMD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PHAM
Last Name:MUPAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13052 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3535
Mailing Address - Country:US
Mailing Address - Phone:714-505-6021
Mailing Address - Fax:
Practice Address - Street 1:13052 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3535
Practice Address - Country:US
Practice Address - Phone:714-505-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist