Provider Demographics
NPI:1013099019
Name:HOM, KENNETH ERIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ERIN
Last Name:HOM
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 1:556 EATON DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2758
Mailing Address - Country:US
Mailing Address - Phone:310-291-9412
Mailing Address - Fax:
Practice Address - Street 1:4502 E AVENUE S
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4480
Practice Address - Country:US
Practice Address - Phone:661-533-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist