Healthcare Provider Details

I. General information

NPI: 1295400703
Provider Name (Legal Business Name): ALISHIA KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 16TH ST
SANTA MONICA CA
90404-1217
US

IV. Provider business mailing address

1316 WELTON WAY
INGLEWOOD CA
90302-1309
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-3784
  • Fax:
Mailing address:
  • Phone: 310-259-8965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: