Provider Demographics
NPI:1396402079
Name:ABDEHOU, NOUSHIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:NOUSHIN
Middle Name:
Last Name:ABDEHOU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14260 LORA DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1207
Mailing Address - Country:US
Mailing Address - Phone:408-420-4003
Mailing Address - Fax:
Practice Address - Street 1:15951 LOS GATOS BLVD STE 12
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3488
Practice Address - Country:US
Practice Address - Phone:408-560-9720
Practice Address - Fax:408-560-9721
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist