Healthcare Provider Details

I. General information

NPI: 1487518627
Provider Name (Legal Business Name): ADASSA NISSAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19015 N 51ST DR
GLENDALE AZ
85308-4915
US

IV. Provider business mailing address

19015 N 51ST DR
GLENDALE AZ
85308-4915
US

V. Phone/Fax

Practice location:
  • Phone: 602-388-0203
  • Fax:
Mailing address:
  • Phone: 602-388-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027812
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: