Provider Demographics
NPI:1659809507
Name:KESHISHIAN NAMAGERDI, ALLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:KESHISHIAN NAMAGERDI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 9TH ST APT 272
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1734
Mailing Address - Country:US
Mailing Address - Phone:818-299-6887
Mailing Address - Fax:
Practice Address - Street 1:111 W 9TH ST APT 272
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1734
Practice Address - Country:US
Practice Address - Phone:818-299-6887
Practice Address - Fax:818-299-6887
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINT35047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist