Provider Demographics
NPI:1811204381
Name:KHOJA, ALLADIN (R PH)
Entity Type:Individual
Prefix:
First Name:ALLADIN
Middle Name:
Last Name:KHOJA
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CANYON CREST DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7973
Mailing Address - Country:US
Mailing Address - Phone:951-279-2921
Mailing Address - Fax:
Practice Address - Street 1:1292 BORDER AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3801
Practice Address - Country:US
Practice Address - Phone:951-735-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 44104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist