Provider Demographics
NPI:1326687518
Name:MAQSOOD, AMBREEN
Entity Type:Individual
Prefix:
First Name:AMBREEN
Middle Name:
Last Name:MAQSOOD
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 1:21729 GOLDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8517
Mailing Address - Country:US
Mailing Address - Phone:626-759-1117
Mailing Address - Fax:
Practice Address - Street 1:21729 GOLDEN OAKS DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8517
Practice Address - Country:US
Practice Address - Phone:626-759-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist