Provider Demographics
NPI:1881396448
Name:SIAGIAN, CLEOPATRA DEBORAH KARINA (PHARMD)
Entity type:Individual
Prefix:
First Name:CLEOPATRA
Middle Name:DEBORAH KARINA
Last Name:SIAGIAN
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 1:7067 PLEASANT VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-6294
Mailing Address - Country:US
Mailing Address - Phone:909-856-2490
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD BLDG 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist