Provider Demographics
NPI:1659656726
Name:VANN, NHAK DEVEAN
Entity Type:Individual
Prefix:
First Name:NHAK
Middle Name:DEVEAN
Last Name:VANN
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 1:1186 CALIMESA BLVD
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1509
Mailing Address - Country:US
Mailing Address - Phone:909-795-1147
Mailing Address - Fax:
Practice Address - Street 1:1186 CALIMESA BLVD
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1509
Practice Address - Country:US
Practice Address - Phone:909-795-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578571835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist