Provider Demographics
NPI:1952422727
Name:ABBOTT, JOAN V (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:V
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:PROF
Other - First Name:JOAN
Other - Middle Name:V
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9854 FOX VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3405
Mailing Address - Country:US
Mailing Address - Phone:858-312-1097
Mailing Address - Fax:858-312-1087
Practice Address - Street 1:315 W WASHINGTON AVE
Practice Address - Street 2:RITE-AID #5629
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-746-2263
Practice Address - Fax:760-746-0549
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist