Provider Demographics
NPI:1922551811
Name:NAGIN, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:NAGIN
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 1:1274 STABLER LN
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2620
Mailing Address - Country:US
Mailing Address - Phone:530-671-5753
Mailing Address - Fax:
Practice Address - Street 1:1274 STABLER LN
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2620
Practice Address - Country:US
Practice Address - Phone:916-802-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist