Healthcare Provider Details

I. General information

NPI: 1720289242
Provider Name (Legal Business Name): ROBIN KAY MCKASSON BOSWELL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18395 BROOKHURST ST
FOUNTAIN VALLEY CA
92708-6705
US

IV. Provider business mailing address

11865 GOODALE AVE
FOUNTAIN VALLEY CA
92708-2608
US

V. Phone/Fax

Practice location:
  • Phone: 714-965-1973
  • Fax: 714-964-0452
Mailing address:
  • Phone: 714-531-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: