Individual
BRAVE SOI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
1401 S BALDWIN AVE, ARCADIA, CA 91007-7922
(626) 445-1284
Mailing address
1401 S BALDWIN AVE, ARCADIA, CA 91007-7922
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
61404
CA
Other
Enumeration date
08/19/2016
Last updated
08/19/2016
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