Provider Demographics
NPI:1699375279
Name:ABRAHAM, NEHA SUSAN
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:SUSAN
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 BEETHOVEN CMN UNIT 300
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5613
Mailing Address - Country:US
Mailing Address - Phone:405-226-1389
Mailing Address - Fax:
Practice Address - Street 1:1138 W TENNYSON RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4422
Practice Address - Country:US
Practice Address - Phone:510-293-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86908183500000X
OK18314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist