Provider Demographics
NPI:1053745463
Name:AGUILAR, HEINEDINE PASCUA (PHARMD)
Entity type:Individual
Prefix:
First Name:HEINEDINE
Middle Name:PASCUA
Last Name:AGUILAR
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 1:1811 S SAN JACINTO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5605
Mailing Address - Country:US
Mailing Address - Phone:951-487-6185
Mailing Address - Fax:951-487-9694
Practice Address - Street 1:1811 S SAN JACINTO AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5605
Practice Address - Country:US
Practice Address - Phone:951-487-6185
Practice Address - Fax:951-487-9694
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist