Kenneth Wahlstrom, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH51053 Issued in CA

Practice address

32401 Camino Capistrano
San Juan Capistrano, CA 92675-4517

Phone

(949) 661-3492

Fax

(949) 661-6205

NPI assigned

Oct 25, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vons Companies Inc

  • Community/Retail Pharmacy
  • San Juan Capistrano, CA
  • NPI 1326084922
  NPD (past)
• Vons Companies Inc

  • Community/Retail Pharmacy
  • Rancho Santa Margarita, CA
  • NPI 1659300689
  NPD (past)
• Vons Companies Inc

  • Community/Retail Pharmacy
  • Santa Monica, CA
  • NPI 1720879919
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1629378609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32401 CAMINO CAPISTRANO",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926754531",
            "telephone_number": "949-661-3492",
            "fax_number": "949-661-6205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32401 CAMINO CAPISTRANO",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926754517",
            "telephone_number": "949-661-3492",
            "fax_number": "949-661-6205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLSTROM",
        "first_name": "KENNETH",
        "name_prefix": "Mr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-25",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "RPH51053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edmund Fredrick Volk III, LMFT
• Vons Companies Inc
• Mirko Vuksic, MPT, OCS, CSCS
• Justin Drew Wagner, PHARMD
• Anisa Waheeduddin, SLPA
• Walk Intuit Inc.
• Lynn Watkins, PT
• Jacob Ryan Watson
• Joshua Drage Watson, PT, DPT
• Nairobi Watson, NP

• Pharmacist in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.