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General NPI Number Information
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NPI Number | 1104304765
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Entity Type | Individual
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Provider Name | ALEXANDER J KELLOGG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2018
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 1720 E 120TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90059-3052
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Country | US
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Telephone | 323-298-3671
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Fax |
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Provider Business Mailing Address
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Address Line | 222 S MAIN ST APT 2236
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City | LOS ANGELES
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State | CA
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Zip | 90012-4572
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Country | US
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Telephone | 309-507-1635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 77828
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License Number State | CA
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