Provider Demographics
NPI:1912436817
Name:CALOZA, BERNADETTE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:CALOZA
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 1:10628 RIVERSIDE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2358
Mailing Address - Country:US
Mailing Address - Phone:818-452-9001
Mailing Address - Fax:
Practice Address - Street 1:10628 RIVERSIDE DR STE 2
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2358
Practice Address - Country:US
Practice Address - Phone:818-452-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist