1497081921 NPI number — PACHARINEE POOLPERM RPH

Table of content: PACHARINEE POOLPERM RPH (NPI 1497081921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497081921 NPI number — PACHARINEE POOLPERM RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POOLPERM
Provider First Name:
PACHARINEE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497081921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3434 CROSSPOINTE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93065-0585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-520-5860
Provider Business Mailing Address Fax Number:
805-520-5860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23388 MULHOLLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91364-2733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-876-4040
Provider Business Practice Location Address Fax Number:
818-876-1398
Provider Enumeration Date:
10/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  41743 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41743 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".