Provider Demographics
NPI:1336351675
Name:RETTIG, MARILOU CRUZ (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:MARILOU
Middle Name:CRUZ
Last Name:RETTIG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24236 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1152
Mailing Address - Country:US
Mailing Address - Phone:818-346-1598
Mailing Address - Fax:818-346-1598
Practice Address - Street 1:24236 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1152
Practice Address - Country:US
Practice Address - Phone:818-346-1598
Practice Address - Fax:818-346-1598
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist