Healthcare Provider Details

I. General information

NPI: 1053125914
Provider Name (Legal Business Name): JOSEPH ARTHUR ANDERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 5TH AVE
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

4077 5TH AVE
SAN DIEGO CA
92103-2105
US

V. Phone/Fax

Practice location:
  • Phone: 858-832-2478
  • Fax:
Mailing address:
  • Phone: 858-832-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11583
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89607
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number123728
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: