Provider Demographics
NPI:1851668347
Name:HADAF, WAHIDA SHOKOOR
Entity Type:Individual
Prefix:MRS
First Name:WAHIDA
Middle Name:SHOKOOR
Last Name:HADAF
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 1:8901 LAGUNA PLACE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-897-9011
Mailing Address - Fax:916-897-9011
Practice Address - Street 1:8901 LAGUNA PLACE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5347
Practice Address - Country:US
Practice Address - Phone:916-897-9011
Practice Address - Fax:916-897-9011
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI DO NOT HAVE IT183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANO NUMBEROtherI DO NOT HAVE ANY IDENTIFICATION NUMBER
CALOOKING FOR NUMBERMedicaid