Provider Demographics
NPI:1568762557
Name:CONCEPCION, ANNE ROSE
Entity Type:Individual
Prefix:MRS
First Name:ANNE ROSE
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4418
Mailing Address - Country:US
Mailing Address - Phone:310-832-0319
Mailing Address - Fax:
Practice Address - Street 1:1440 W 25TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4418
Practice Address - Country:US
Practice Address - Phone:310-832-0319
Practice Address - Fax:310-832-1142
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist