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Organization
WALNUT VILLAGE PHARMACY INC
Active
Organization
WALNUT VILLAGE PHARMACY INC
Active
Other names
WALNUT VILLAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRED B KIM PHARM.D. (OWNER, PHARMACIST IN CHARGE)
(949) 551-4343
Entity
Organization
Contact information
Practice address
4840 IRVINE BLVD. STE 103, IRVINE, CA 92620-1962
(949) 551-4343
(949) 551-3078
Mailing address
4840 IRVINE BLVD. STE 103, IRVINE, CA 92620-1962
(949) 551-4343
(949) 551-3078
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002056
PK
—
05
—
PHA508560
—
CA
Enumeration date
12/04/2006
Last updated
08/28/2020
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