Provider Demographics
NPI:1013341668
Name:KAW, DEBRA NOELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:NOELLE
Last Name:KAW
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 1:774 VIA COLINAS
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5060
Mailing Address - Country:US
Mailing Address - Phone:703-407-9428
Mailing Address - Fax:
Practice Address - Street 1:3941 SPRING RD
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2300
Practice Address - Country:US
Practice Address - Phone:805-529-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist