Provider Demographics
NPI:1053814012
Name:AKAYVAN, ANNA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:AKAYVAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5169 CATOCTIN DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1518
Mailing Address - Country:US
Mailing Address - Phone:858-212-1137
Mailing Address - Fax:
Practice Address - Street 1:1150 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2707
Practice Address - Country:US
Practice Address - Phone:858-212-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67058183500000X, 1835P0018X, 3336I0012X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No3336I0012XSuppliersPharmacyInstitutional Pharmacy