Provider Demographics
NPI:1871813428
Name:MAK, REBECCA C (PHARM D)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:C
Last Name:MAK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 SENECA PL
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4369
Mailing Address - Country:US
Mailing Address - Phone:909-613-1191
Mailing Address - Fax:909-591-1657
Practice Address - Street 1:1148 SENECA PL
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4369
Practice Address - Country:US
Practice Address - Phone:909-613-1191
Practice Address - Fax:909-591-1657
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA329441835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist