Provider Demographics
NPI:1538948617
Name:HUANG, CARISSA (RPH)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:HUANG
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 1:171 FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-4005
Mailing Address - Country:US
Mailing Address - Phone:415-672-5375
Mailing Address - Fax:
Practice Address - Street 1:171 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-4005
Practice Address - Country:US
Practice Address - Phone:415-672-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist