Provider Demographics
NPI:1831780360
Name:MANUEL, IVEE ROZETTE PAJARILLO
Entity type:Individual
Prefix:
First Name:IVEE ROZETTE
Middle Name:PAJARILLO
Last Name:MANUEL
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 1:147 N VICEROY AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3940
Mailing Address - Country:US
Mailing Address - Phone:626-484-5709
Mailing Address - Fax:
Practice Address - Street 1:147 N VICEROY AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-3940
Practice Address - Country:US
Practice Address - Phone:626-484-5709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH82474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist