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General NPI Number Information
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NPI Number | 1578642245
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Entity Type | Organization
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Legal Business Name | KIM SON PHARMACY
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 625 E VALLEY BLVD SUITE J
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3591
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Country | US
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Telephone | 626-571-5967
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Fax | 626-571-5968
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Provider Business Mailing Address
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Address Line | 625 E VALLEY BLVD STE J
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3591
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Country | US
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Telephone | 626-571-5967
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Fax | 626-571-5968
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Authorized Official
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Title or Position | PIC
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Name | KIM CHI NGUYEN
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Credential |
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Telephone | 626-571-5967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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