Provider Demographics
NPI:1871294850
Name:ABELLANA, CHARLES KEOLA
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEOLA
Last Name:ABELLANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FAIRMONT SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1240
Mailing Address - Country:US
Mailing Address - Phone:650-355-5810
Mailing Address - Fax:650-355-5882
Practice Address - Street 1:200 FAIRMONT SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1240
Practice Address - Country:US
Practice Address - Phone:650-355-5810
Practice Address - Fax:650-355-5882
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH186885183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician