Provider Demographics
NPI:1316473747
Name:BULGATZ, MYRA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:BULGATZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E H ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7483
Mailing Address - Country:US
Mailing Address - Phone:619-426-0866
Mailing Address - Fax:619-426-6251
Practice Address - Street 1:380 E H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7483
Practice Address - Country:US
Practice Address - Phone:619-426-0866
Practice Address - Fax:619-426-6251
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist