Basic Information
Provider Information
NPI: 1639634041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALOIAU
FirstName: AIMEE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 327 SAN MARCOS ST APT C
Address2:  
City: SAN GABRIEL
State: CA
PostalCode: 917761091
CountryCode: US
TelephoneNumber: 8083875996
FaxNumber:  
Practice Location
Address1: 4867 W SUNSET BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900275969
CountryCode: US
TelephoneNumber: 3237834011
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/10/2019
LastUpdateDate: 02/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X66202CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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