Healthcare Provider Details

I. General information

NPI: 1154864486
Provider Name (Legal Business Name): ANTHONY DIKDAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 LOMITA BLVD
TORRANCE CA
90505-5214
US

IV. Provider business mailing address

2640 LOMITA BLVD
TORRANCE CA
90505-5214
US

V. Phone/Fax

Practice location:
  • Phone: 310-891-1026
  • Fax:
Mailing address:
  • Phone: 310-891-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: