Provider Demographics
NPI:1699593087
Name:KAPUSTOVA, KAROLINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAROLINA
Middle Name:
Last Name:KAPUSTOVA
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 1:34147 RED BERRY LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-1744
Mailing Address - Country:US
Mailing Address - Phone:562-682-3788
Mailing Address - Fax:
Practice Address - Street 1:34147 RED BERRY LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-1744
Practice Address - Country:US
Practice Address - Phone:562-682-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist