Provider Demographics
NPI:1720444995
Name:ESKANDAR, MINA
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:ESKANDAR
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 1:733 E MAIN ST
Mailing Address - Street 2:CVS PHARMACY
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4507
Mailing Address - Country:US
Mailing Address - Phone:805-922-2040
Mailing Address - Fax:805-349-0048
Practice Address - Street 1:733 E MAIN ST
Practice Address - Street 2:CVS PHARMACY
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4507
Practice Address - Country:US
Practice Address - Phone:805-922-2040
Practice Address - Fax:805-349-0048
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA724222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist