Provider Demographics
NPI:1780247148
Name:LUSTINA, ARACELI (RPH)
Entity type:Individual
Prefix:
First Name:ARACELI
Middle Name:
Last Name:LUSTINA
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 1:3900 SACRAMENTO DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6885
Mailing Address - Country:US
Mailing Address - Phone:619-316-0279
Mailing Address - Fax:
Practice Address - Street 1:2760 FLETCHER PKWY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2110
Practice Address - Country:US
Practice Address - Phone:619-461-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist