Provider Demographics
NPI:1184919938
Name:MAYOR, MARCHIE MAGALLANES
Entity type:Individual
Prefix:
First Name:MARCHIE
Middle Name:MAGALLANES
Last Name:MAYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29196 WOODFALL DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5891
Mailing Address - Country:US
Mailing Address - Phone:951-658-3418
Mailing Address - Fax:951-652-6874
Practice Address - Street 1:260 N SANDERSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3614
Practice Address - Country:US
Practice Address - Phone:951-658-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist