Provider Demographics
NPI:1578029195
Name:ANWER, MADONNA EMAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:EMAD
Last Name:ANWER
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 1:10400 ARROW RTE APT P10
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4779
Mailing Address - Country:US
Mailing Address - Phone:626-393-6815
Mailing Address - Fax:
Practice Address - Street 1:41865 BOARDWALK # 1B
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9026
Practice Address - Country:US
Practice Address - Phone:626-393-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist