Healthcare Provider Details

I. General information

NPI: 1902579527
Provider Name (Legal Business Name): ELIZABETH ANDERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16773 BERNARDO CENTER DR
SAN DIEGO CA
92128-2525
US

IV. Provider business mailing address

401 HIGHLAND OAKS LN
FALLBROOK CA
92028-8098
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-2630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number83651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: