Provider Demographics
NPI:1346610656
Name:KIM, ANNA S (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11878 AVENUE OF INDUSTRY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3423
Mailing Address - Country:US
Mailing Address - Phone:858-675-4259
Mailing Address - Fax:858-485-5418
Practice Address - Street 1:11878 AVENUE OF INDUSTRY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3423
Practice Address - Country:US
Practice Address - Phone:858-675-4259
Practice Address - Fax:858-485-5418
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 58072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist