Provider Demographics
NPI:1568915239
Name:NISHI, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:NISHI
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 1:41093 COUNTY CENTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6025
Mailing Address - Country:US
Mailing Address - Phone:951-296-2500
Mailing Address - Fax:877-432-6258
Practice Address - Street 1:41093 COUNTY CENTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6025
Practice Address - Country:US
Practice Address - Phone:951-296-2500
Practice Address - Fax:877-432-6258
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist