Provider Demographics
NPI:1174120059
Name:ANN, AARON
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:ANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 LOXLEY PL
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4813
Mailing Address - Country:US
Mailing Address - Phone:909-771-9631
Mailing Address - Fax:
Practice Address - Street 1:30491 AVENIDA DE LAS FLORES
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3923
Practice Address - Country:US
Practice Address - Phone:949-207-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist