Provider Demographics
NPI:1902180250
Name:MEYER, KIMLONG THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMLONG
Middle Name:THI
Last Name:MEYER
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 1:6199 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-6834
Mailing Address - Country:US
Mailing Address - Phone:916-726-6802
Mailing Address - Fax:916-726-6834
Practice Address - Street 1:6199 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-6834
Practice Address - Country:US
Practice Address - Phone:916-726-6802
Practice Address - Fax:916-726-6834
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist