Provider Demographics
NPI:1376155853
Name:WERAB, AUSTEN MARIO (PHARMD)
Entity type:Individual
Prefix:
First Name:AUSTEN
Middle Name:MARIO
Last Name:WERAB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S HOPE ST APT 1804
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4716
Mailing Address - Country:US
Mailing Address - Phone:239-249-2608
Mailing Address - Fax:
Practice Address - Street 1:11975 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2541
Practice Address - Country:US
Practice Address - Phone:323-442-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2025-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH90891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist