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NPI Code Detail

MEDICARE: DR. KRISTINE LYNN BOOTH PHARMD

MEDICARE: DR. KRISTINE LYNN BOOTH PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist79533CA

General Provider Information

NPI Number : 1841766177
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTINE LYNN BOOTH PHARMD
Provider Business Mailing Address
First Line : 8700 PERSHING DR UNIT 3206
Second Line :
City : PLAYA DEL REY
State : CA
Zip : 90293-8010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2169 W REDONDO BEACH BLVD
Second Line :
City : GARDENA
State : CA
Zip : 90247-3625
Country : US
Telephone Number : 310-515-3783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2018
Last Update Date : 10/13/2018

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