Provider Demographics
NPI:1225375264
Name:TRIVEDI, ASHISH R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:R
Last Name:TRIVEDI
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 1:21236 GRANITE WELLS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21236 GRANITE WELLS DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1344
Practice Address - Country:US
Practice Address - Phone:310-439-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744R1102X, 174H00000X
CA68549183500000X, 1835N1003X, 1835P0018X, 1835P1200X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1744R1102XOther Service ProvidersSpecialistResearch Study
No174H00000XOther Service ProvidersHealth Educator
No183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835X0200XPharmacy Service ProvidersPharmacistOncology