Provider Demographics
NPI:1033582143
Name:HADDADIN, SHADI
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:HADDADIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 QUAIL RUN WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-6280
Mailing Address - Country:US
Mailing Address - Phone:312-890-9027
Mailing Address - Fax:
Practice Address - Street 1:2480 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2141
Practice Address - Country:US
Practice Address - Phone:805-985-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist