Provider Demographics
NPI:1518637636
Name:AHN, LUCY HAEMIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:HAEMIN
Last Name:AHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HYEI
Other - Middle Name:MIN
Other - Last Name:AHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 MERRYDALE RD APT 19
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3957
Mailing Address - Country:US
Mailing Address - Phone:858-761-2250
Mailing Address - Fax:
Practice Address - Street 1:431 CORTE MADERA TOWN CTR
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1215
Practice Address - Country:US
Practice Address - Phone:415-924-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH84581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH84581OtherCA BOP