Provider Demographics
NPI:1205595287
Name:ORIGINALES, CHIEN (PHARMD)
Entity type:Individual
Prefix:
First Name:CHIEN
Middle Name:
Last Name:ORIGINALES
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 1:31960 TEAL CT
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-7205
Mailing Address - Country:US
Mailing Address - Phone:909-910-4837
Mailing Address - Fax:
Practice Address - Street 1:31960 TEAL CT
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-7205
Practice Address - Country:US
Practice Address - Phone:909-919-4837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist