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General NPI Number Information
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NPI Number | 1053412411
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Entity Type | Organization
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Legal Business Name | MADELEINE LORD
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 657 E UNIVERSITY DR
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City | CARSON
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State | CA
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Zip | 90746-1966
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Country | US
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Telephone | 310-323-6193
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Fax |
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Provider Business Mailing Address
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Address Line | 657 E UNIVERSITY DR
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City | CARSON
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State | CA
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Zip | 90746-1966
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Country | US
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Telephone | 310-323-6193
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MADELEINE LORD
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Credential |
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Telephone | 310-323-6193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHY39951
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License Number State | CA
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