Provider Demographics
NPI:1023205291
Name:MANDAVIA, NIHAR NIRANJAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NIHAR
Middle Name:NIRANJAN
Last Name:MANDAVIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27881 LA PAZ RD STE E
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3933
Mailing Address - Country:US
Mailing Address - Phone:949-643-0740
Mailing Address - Fax:
Practice Address - Street 1:27881 LA PAZ RD STE E
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3933
Practice Address - Country:US
Practice Address - Phone:949-643-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55055183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist