Healthcare Provider Details

I. General information

NPI: 1477038362
Provider Name (Legal Business Name): KEITH MICHAEL DAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S HOOVER ST
LOS ANGELES CA
90007-1322
US

IV. Provider business mailing address

1919 S HOOVER ST
LOS ANGELES CA
90007-1322
US

V. Phone/Fax

Practice location:
  • Phone: 213-741-6099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number78974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: