Provider Demographics
NPI:1912275116
Name:MAI, ALISHA SHUFEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:SHUFEN
Last Name:MAI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:SHU-FEN
Other - Middle Name:
Other - Last Name:MAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4839
Mailing Address - Country:US
Mailing Address - Phone:650-737-5735
Mailing Address - Fax:
Practice Address - Street 1:333 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4839
Practice Address - Country:US
Practice Address - Phone:650-737-5735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist