Provider Demographics
NPI:1245564848
Name:SERUMGARD, KIRK ANTHONY (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:ANTHONY
Last Name:SERUMGARD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475A WEST 12TH STREET BLDG 780-A
Mailing Address - Street 2:B/CO. 352 CSH USAR
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-5780
Mailing Address - Country:US
Mailing Address - Phone:510-302-2733
Mailing Address - Fax:
Practice Address - Street 1:B/CO. 352 CSH USAR
Practice Address - Street 2:2475A WEST 12TH STREET BLDG 780-A
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:94607-5780
Practice Address - Country:US
Practice Address - Phone:510-302-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59365OtherBOARD OF PHARMACY