Provider Demographics
NPI:1629155296
Name:NILES, LOREN ABAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:ABAD
Last Name:NILES
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 1:1761 BROADWAY ST STE 209
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2227
Mailing Address - Country:US
Mailing Address - Phone:707-645-2522
Mailing Address - Fax:707-645-2530
Practice Address - Street 1:1761 BROADWAY ST STE 209
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2227
Practice Address - Country:US
Practice Address - Phone:707-645-2522
Practice Address - Fax:707-645-2530
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist