Provider Demographics
NPI:1306260039
Name:SO-ROSILLO, CONJA (PHARMD)
Entity type:Individual
Prefix:
First Name:CONJA
Middle Name:
Last Name:SO-ROSILLO
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 1:1881 SERPENTINE DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4687
Mailing Address - Country:US
Mailing Address - Phone:510-274-8212
Mailing Address - Fax:
Practice Address - Street 1:1905 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2216
Practice Address - Country:US
Practice Address - Phone:650-967-3531
Practice Address - Fax:650-625-9474
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH52616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist