Healthcare Provider Details

I. General information

NPI: 1588395727
Provider Name (Legal Business Name): ALLISON RAN HUR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15434 ILLORA DR
LA MIRADA CA
90638-4834
US

IV. Provider business mailing address

15434 ILLORA DR
LA MIRADA CA
90638-4834
US

V. Phone/Fax

Practice location:
  • Phone: 714-315-5209
  • Fax:
Mailing address:
  • Phone: 714-315-5209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: