Healthcare Provider Details

I. General information

NPI: 1164146593
Provider Name (Legal Business Name): NICK LIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11047 CAMINO PLAYA CARMEL
SAN DIEGO CA
92124-4140
US

IV. Provider business mailing address

11047 CAMINO PLAYA CARMEL
SAN DIEGO CA
92124-4140
US

V. Phone/Fax

Practice location:
  • Phone: 267-541-4112
  • Fax:
Mailing address:
  • Phone: 267-541-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH86513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: