Provider Demographics
NPI:1447881602
Name:DE LA CRUZ, CARMELIE NEIL (RPH)
Entity type:Individual
Prefix:
First Name:CARMELIE
Middle Name:NEIL
Last Name:DE LA CRUZ
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 1:15037 ROXFORD ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-8376
Mailing Address - Country:US
Mailing Address - Phone:818-259-3903
Mailing Address - Fax:
Practice Address - Street 1:19331 BUSINESS CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3533
Practice Address - Country:US
Practice Address - Phone:818-882-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist