Provider Demographics
NPI:1053694554
Name:MIJARES, LUCIA J (RPH)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:J
Last Name:MIJARES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SUMMERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-3180
Mailing Address - Country:US
Mailing Address - Phone:707-853-7527
Mailing Address - Fax:
Practice Address - Street 1:127 SUMMERWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503
Practice Address - Country:US
Practice Address - Phone:707-853-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist