Healthcare Provider Details

I. General information

NPI: 1356853626
Provider Name (Legal Business Name): LORI LIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N HARBOR BLVD
FULLERTON CA
92832-1312
US

IV. Provider business mailing address

1121 N HARBOR BLVD
FULLERTON CA
92832-1312
US

V. Phone/Fax

Practice location:
  • Phone: 714-992-6313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: