Provider Demographics
NPI:1821120023
Name:KAISHAR, JOYCE GABRIEL
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:GABRIEL
Last Name:KAISHAR
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 1:2659 S BUENOS AIRES DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3917
Mailing Address - Country:US
Mailing Address - Phone:818-621-9586
Mailing Address - Fax:818-244-7700
Practice Address - Street 1:501 E HARVARD ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1114
Practice Address - Country:US
Practice Address - Phone:818-621-9586
Practice Address - Fax:818-244-7700
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46098183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician