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General NPI Number Information
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NPI Number | 1063695690
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Entity Type | Organization
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Legal Business Name | CLINICAL INTERVENTION GROUP, LLC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 801 N BRAND BLVD SUITE 630
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City | GLENDALE
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State | CA
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Zip | 91203-1237
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Country | US
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Telephone | 888-674-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 801 N BRAND BLVD SUITE 630
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City | GLENDALE
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State | CA
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Zip | 91203-1237
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Country | US
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Telephone | 888-674-6060
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. ESAN FORDE
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Credential | PHARM.D, CGP, MS
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Telephone | 888-674-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number |
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License Number State |
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