Active NPI
Alisa Kusolvisitkul, PHARMD
- Pharmacist
- Los Angeles, CA
National Provider Identifier
1912288945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PHA66994
- Practice address
- 1902 Marengo St Ste 105
Los Angeles, CA 90033-1378 - Phone
- (323) 405-0417
- NPI assigned
- Sep 4, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.293807 | IL | |
| Pharmacist | 183500000X | PHA66994 | CA | Primary |
Addresses
Primary practice location
1902 Marengo St Ste 105
Los Angeles, CA 90033-1378
Mailing address
1902 Marengo St Ste 105
Los Angeles, CA 90033-1378
Phone (323) 405-0417
Other practice location 1
934 N Hacienda Blvd
La Puente, CA 91744-2845
Phone (626) 934-1926
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PHA66994 | CA | MD | Pharmacist |
| 051.293807 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1902 Marengo St
Ste 105
Los Angeles, CA 90033
Phone (323) 405-0417
Organizations & group practices 3
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672012800000",
"number": "1912288945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1902 MARENGO ST STE 105",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331378",
"telephone_number": "323-405-0417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1902 MARENGO ST STE 105",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331378",
"telephone_number": "323-405-0417"
}
],
"practiceLocations": [
{
"address_1": "934 N Hacienda Blvd",
"address_purpose": "LOCATION",
"city": "La Puente",
"state": "CA",
"postal_code": "917442845",
"country_code": "US",
"telephone_number": "626-934-1926",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KUSOLVISITKUL",
"first_name": "ALISA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-04",
"last_updated": "2022-12-26",
"certification_date": "2022-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.293807",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "PHA66994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.