Healthcare Provider Details

I. General information

NPI: 1316512940
Provider Name (Legal Business Name): KERRY FAY FIXEN PHARMACY TECH LICENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21949 VENTURA BLVD
WOODLAND HILLS CA
91364-1725
US

IV. Provider business mailing address

162 CAMINO RUIZ
CAMARILLO CA
93012-6782
US

V. Phone/Fax

Practice location:
  • Phone: 881-348-5542
  • Fax:
Mailing address:
  • Phone: 805-201-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH21621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: