Provider Demographics
NPI:1295000537
Name:GLASSON, KIMBERLEY (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:GLASSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 MURPHY CANYON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4451
Mailing Address - Country:US
Mailing Address - Phone:619-670-5921
Mailing Address - Fax:
Practice Address - Street 1:3875 AVOCADO BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7303
Practice Address - Country:US
Practice Address - Phone:619-670-2050
Practice Address - Fax:619-670-2119
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist