Provider Demographics
NPI:1366211286
Name:CORPUZ, ROSALIE PUNZALAN (RPH)
Entity type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:PUNZALAN
Last Name:CORPUZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19336 BRANDING IRON RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4215
Mailing Address - Country:US
Mailing Address - Phone:626-825-5327
Mailing Address - Fax:
Practice Address - Street 1:600 N MOUNTAIN AVE STE E
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4359
Practice Address - Country:US
Practice Address - Phone:909-256-3663
Practice Address - Fax:909-377-5025
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH31177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist