Provider Demographics
NPI:1770212177
Name:KOLTA, NOHA (RPH)
Entity Type:Individual
Prefix:
First Name:NOHA
Middle Name:
Last Name:KOLTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10374 TRADEMARK ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5824
Mailing Address - Country:US
Mailing Address - Phone:909-477-6300
Mailing Address - Fax:909-477-3009
Practice Address - Street 1:10374 TRADEMARK ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5824
Practice Address - Country:US
Practice Address - Phone:909-477-6300
Practice Address - Fax:909-477-3009
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist