Provider Demographics
NPI:1871876664
Name:ISUSQUIZA, MARISOL (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:ISUSQUIZA
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 1:888 W ARROW HWY
Mailing Address - Street 2:T-0767
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2495
Mailing Address - Country:US
Mailing Address - Phone:909-962-9000
Mailing Address - Fax:909-962-9000
Practice Address - Street 1:888 W ARROW HWY
Practice Address - Street 2:T-0767
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2495
Practice Address - Country:US
Practice Address - Phone:909-962-9000
Practice Address - Fax:909-962-9000
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist