Provider Demographics
NPI:1710267430
Name:ASSILIAN, NADIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:NADIN
Middle Name:
Last Name:ASSILIAN
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 1:22477 EL TORO RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5050
Mailing Address - Country:US
Mailing Address - Phone:949-855-9832
Mailing Address - Fax:
Practice Address - Street 1:22477 EL TORO RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5050
Practice Address - Country:US
Practice Address - Phone:949-855-9832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist