Provider Demographics
NPI:1831644160
Name:ALEX, NITTY
Entity Type:Individual
Prefix:
First Name:NITTY
Middle Name:
Last Name:ALEX
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 1:25947 STAFFORD CANYON RD UNIT G
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1555
Mailing Address - Country:US
Mailing Address - Phone:562-547-1492
Mailing Address - Fax:
Practice Address - Street 1:451 S SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-5270
Practice Address - Country:US
Practice Address - Phone:626-564-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist