Provider Demographics
NPI:1760711295
Name:BIRKELAND, KADE THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KADE
Middle Name:THOMAS
Last Name:BIRKELAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 WELLESLEY AVENUE
Mailing Address - Street 2:APT 9
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:33458-6983
Mailing Address - Country:US
Mailing Address - Phone:406-461-6246
Mailing Address - Fax:
Practice Address - Street 1:250 N. ROBERTSON BLVD
Practice Address - Street 2:SUITE 606
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:406-461-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT67221835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist