Provider Demographics
NPI:1508393307
Name:VAN NIEKERK, MONIEN (BPHARM)
Entity Type:Individual
Prefix:
First Name:MONIEN
Middle Name:
Last Name:VAN NIEKERK
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30640 RANCHO CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3276
Mailing Address - Country:US
Mailing Address - Phone:951-695-1713
Mailing Address - Fax:951-699-4862
Practice Address - Street 1:30640 RANCHO CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3276
Practice Address - Country:US
Practice Address - Phone:951-695-1713
Practice Address - Fax:951-699-4862
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist