Individual
ALISA KUSOLVISITKUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1902 MARENGO ST STE 105, LOS ANGELES, CA 90033-1378
(323) 405-0417
Mailing address
1902 MARENGO ST STE 105, LOS ANGELES, CA 90033-1378
(323) 405-0417
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051.293807
IL
183500000X
Pharmacist
Primary
PHA66994
CA
Other
Enumeration date
09/04/2011
Last updated
12/26/2022
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