Provider Demographics
NPI:1316512940
Name:FIXEN, KERRY FAY (PHARMACY TECH LICENS)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:FAY
Last Name:FIXEN
Suffix:
Gender:F
Credentials:PHARMACY TECH LICENS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CAMINO RUIZ
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-6782
Mailing Address - Country:US
Mailing Address - Phone:805-201-5059
Mailing Address - Fax:
Practice Address - Street 1:21949 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1725
Practice Address - Country:US
Practice Address - Phone:881-348-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH21621183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician