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General NPI Number Information
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NPI Number | 1558825836
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Entity Type | Individual
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Provider Name | KIMBERLY GAIL WAKE RPH
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Gender | Female
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 9521 DALEN ST
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City | DOWNEY
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State | CA
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Zip | 90242-4847
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Country | US
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Telephone | 562-501-2482
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Fax |
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Provider Business Mailing Address
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Address Line | 16312 HEARTWOOD CT
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City | LA MIRADA
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State | CA
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Zip | 90638-6516
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 47406
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License Number State | CA
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