Healthcare Provider Details

I. General information

NPI: 1578111001
Provider Name (Legal Business Name): KEVIN BOX PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

1575 EBERS ST
SAN DIEGO CA
92107-3560
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5599
  • Fax:
Mailing address:
  • Phone: 619-822-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number46276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: