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General NPI Number Information
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NPI Number | 1710432174
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Entity Type | Individual
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Provider Name | KIMBERLY HOLDEN SHAKUR PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 757 WESTWOOD PLZ B504A
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City | LOS ANGELES
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State | CA
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Zip | 90095-8358
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Country | US
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Telephone | 310-267-7721
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Fax |
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Provider Business Mailing Address
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Address Line | 6320 GREEN VALLEY CIR APT 200
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City | CULVER CITY
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State | CA
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Zip | 90230-7078
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Country | US
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Telephone | 352-514-5582
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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 | 62797
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS40114
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26380
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH3725
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License Number State | HI
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