Provider Demographics
NPI:1033828413
Name:MAINALY, NIKITA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:MAINALY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SAN RAMON WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2840
Mailing Address - Country:US
Mailing Address - Phone:714-594-8845
Mailing Address - Fax:
Practice Address - Street 1:1344 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3356
Practice Address - Country:US
Practice Address - Phone:310-353-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist