Provider Demographics
NPI:1346739471
Name:HEDDADJI, SALIHA
Entity Type:Individual
Prefix:
First Name:SALIHA
Middle Name:
Last Name:HEDDADJI
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 1:6057 W BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4501
Mailing Address - Country:US
Mailing Address - Phone:571-258-8500
Mailing Address - Fax:925-364-9208
Practice Address - Street 1:9100 ALCOSTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3857
Practice Address - Country:US
Practice Address - Phone:925-364-9217
Practice Address - Fax:925-364-9208
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist