Provider Demographics
NPI:1225451396
Name:KESHISH, ADRINEH
Entity Type:Individual
Prefix:
First Name:ADRINEH
Middle Name:
Last Name:KESHISH
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 1:10515 BALBOA BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6354
Mailing Address - Country:US
Mailing Address - Phone:747-600-5999
Mailing Address - Fax:
Practice Address - Street 1:428 HAWTHORNE ST APT 113
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3107
Practice Address - Country:US
Practice Address - Phone:818-808-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist