Provider Demographics
NPI:1447606090
Name:ALDASORO, ADRIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:ALDASORO
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 1:1564 W BASE LINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1712
Mailing Address - Country:US
Mailing Address - Phone:909-381-6944
Mailing Address - Fax:909-381-3034
Practice Address - Street 1:1564 W BASE LINE ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1712
Practice Address - Country:US
Practice Address - Phone:909-381-6944
Practice Address - Fax:909-381-3034
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist