Provider Demographics
NPI:1598390437
Name:ALFRED, ASHRAF
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:ALFRED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12940 RILEY CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8850
Mailing Address - Country:US
Mailing Address - Phone:909-227-0343
Mailing Address - Fax:909-493-1501
Practice Address - Street 1:10431 LEMON AVE STE G
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3763
Practice Address - Country:US
Practice Address - Phone:909-493-1500
Practice Address - Fax:909-493-1501
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist