Provider Demographics
NPI:1417503913
Name:ANZLOVAR, KENNETH VICTOR
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:VICTOR
Last Name:ANZLOVAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24031 MARGUERITE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1929
Mailing Address - Country:US
Mailing Address - Phone:949-586-1700
Mailing Address - Fax:949-586-4683
Practice Address - Street 1:24031 MARGUERITE PKWY STE A
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1929
Practice Address - Country:US
Practice Address - Phone:949-586-1700
Practice Address - Fax:949-586-4683
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist