Provider Demographics
NPI:1740271972
Name:AKSENTIJEVIC, KIMBERLY BRIANO (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BRIANO
Last Name:AKSENTIJEVIC
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 1:3942 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4645
Mailing Address - Country:US
Mailing Address - Phone:818-501-3104
Mailing Address - Fax:818-788-4870
Practice Address - Street 1:6000 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6310
Practice Address - Country:US
Practice Address - Phone:818-781-3364
Practice Address - Fax:818-781-3527
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH038483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist