Healthcare Provider Details

I. General information

NPI: 1255611109
Provider Name (Legal Business Name): LYDIA KRIN SIM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYDIA KRIN

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date: 04/28/2017
Reactivation Date: 02/24/2021

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-328-8809
  • Fax:
Mailing address:
  • Phone: 562-933-7948
  • Fax: 562-933-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: