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General NPI Number Information
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NPI Number | 1851417885
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Entity Type | Individual
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Provider Name | WESLEY ALLEN ANDERSEN R.PH.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 01/12/2013
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Provider Practice Location Address
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Address Line | 1223 16TH ST RM 1202
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City | SANTA MONICA
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State | CA
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Zip | 90404-1217
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Country | US
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Telephone | 760-325-9370
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Fax |
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Provider Business Mailing Address
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Address Line | 851 N KINGS RD APT 109
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-5931
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Country | US
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Telephone | 323-944-0710
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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 | 53637
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License Number State | CA
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