Provider Demographics
NPI:1386451557
Name:CLARET, TRISHA ANGELINE
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANGELINE
Last Name:CLARET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12205 CRYSTAL HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3874
Mailing Address - Country:US
Mailing Address - Phone:360-318-3505
Mailing Address - Fax:
Practice Address - Street 1:4311 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-8814
Practice Address - Country:US
Practice Address - Phone:310-821-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist