Listiawan, Mario

Listiawan, Mario is an sole proprietor health care provider with primary practice located at 10811 International Dr , Rancho Cordova CA 95670-7368. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Listiawan, Mario can be contacted via phone (916) 503-1910.

Contact Information

Primary practice address
10811 International Dr Rancho Cordova CA 95670-7368
Phone: (916) 503-1910
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 65574 California

Profile Details

NPI number 1295006609
LBN Legal business name Listiawan, Mario
Credentials PHARMD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 16th, 2012
Last updated Jan 16th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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