Provider Demographics
NPI:1215022090
Name:ABDUL NOUR, CHADI (RPH , APH, CDE)
Entity Type:Individual
Prefix:DR
First Name:CHADI
Middle Name:
Last Name:ABDUL NOUR
Suffix:
Gender:M
Credentials:RPH , APH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WILLOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4852
Mailing Address - Country:US
Mailing Address - Phone:626-827-2835
Mailing Address - Fax:
Practice Address - Street 1:42 WILLOWBROOK LN
Practice Address - Street 2:
Practice Address - City:PHILLIPS RANCH
Practice Address - State:CA
Practice Address - Zip Code:91766-4852
Practice Address - Country:US
Practice Address - Phone:626-827-2835
Practice Address - Fax:626-261-4450
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52504OtherSTATE PHARMACIST LICENSE