Provider Demographics
NPI:1134880941
Name:COLABAWALA, ADIL AMIRALI
Entity type:Individual
Prefix:
First Name:ADIL
Middle Name:AMIRALI
Last Name:COLABAWALA
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 1:8821 LINDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3024
Mailing Address - Country:US
Mailing Address - Phone:818-573-7747
Mailing Address - Fax:
Practice Address - Street 1:4030 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1634
Practice Address - Country:US
Practice Address - Phone:323-292-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist