Provider Demographics
NPI:1396029500
Name:IM, MEA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEA
Middle Name:M
Last Name:IM
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 1:2690 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7038
Mailing Address - Country:US
Mailing Address - Phone:310-517-0351
Mailing Address - Fax:310-517-1889
Practice Address - Street 1:2690 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7038
Practice Address - Country:US
Practice Address - Phone:310-517-0351
Practice Address - Fax:310-517-1889
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 62927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 62927OtherCA BOARD OF PHARMACY