Provider Demographics
NPI:1821320631
Name:EMDADIAN, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:EMDADIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1607
Mailing Address - Country:US
Mailing Address - Phone:530-510-1303
Mailing Address - Fax:
Practice Address - Street 1:640 EDITH AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-2349
Practice Address - Country:US
Practice Address - Phone:530-824-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist