Provider Demographics
NPI:1770795684
Name:ARCERITO, KIM NGUYEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:NGUYEN
Last Name:ARCERITO
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 1:3333 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3252
Mailing Address - Country:US
Mailing Address - Phone:951-276-9319
Mailing Address - Fax:951-241-8579
Practice Address - Street 1:3333 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3252
Practice Address - Country:US
Practice Address - Phone:951-276-9319
Practice Address - Fax:951-241-8579
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040391183500000X
MD13484183500000X
CA46455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist