Provider Demographics
NPI:1790062958
Name:ABRAHAM, NEAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:
Last Name:ABRAHAM
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 1:12490 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2603
Mailing Address - Country:US
Mailing Address - Phone:909-464-9520
Mailing Address - Fax:909-464-9910
Practice Address - Street 1:12490 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2603
Practice Address - Country:US
Practice Address - Phone:909-464-9520
Practice Address - Fax:909-464-9910
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist