Provider Demographics
NPI:1538855671
Name:SIAZON, KAREN DIANNE (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DIANNE
Last Name:SIAZON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2611
Mailing Address - Country:US
Mailing Address - Phone:714-342-7557
Mailing Address - Fax:
Practice Address - Street 1:26762 PORTOLA PKWY
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92610-1712
Practice Address - Country:US
Practice Address - Phone:949-454-0327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist