Provider Demographics
NPI:1356986640
Name:LLAMAS, MARIEL KRYSTEL V (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIEL KRYSTEL
Middle Name:V
Last Name:LLAMAS
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 1:3461 ATWATER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1915
Mailing Address - Country:US
Mailing Address - Phone:323-807-6300
Mailing Address - Fax:
Practice Address - Street 1:150 E GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207
Practice Address - Country:US
Practice Address - Phone:818-745-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH80513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist