Provider Demographics
NPI:1083087670
Name:ALLAHABADI, NITASHA
Entity Type:Individual
Prefix:
First Name:NITASHA
Middle Name:
Last Name:ALLAHABADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2531
Mailing Address - Country:US
Mailing Address - Phone:626-969-6669
Mailing Address - Fax:626-969-6565
Practice Address - Street 1:101 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2531
Practice Address - Country:US
Practice Address - Phone:626-969-6669
Practice Address - Fax:626-969-6565
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist