Provider Demographics
NPI:1790453801
Name:INAM, NAUREEN
Entity Type:Individual
Prefix:
First Name:NAUREEN
Middle Name:
Last Name:INAM
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 1:2810 MENORCA CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4608
Mailing Address - Country:US
Mailing Address - Phone:951-525-0128
Mailing Address - Fax:
Practice Address - Street 1:191 WOODLAND PKWY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3010
Practice Address - Country:US
Practice Address - Phone:760-471-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist