Healthcare Provider Details

I. General information

NPI: 1659809507
Provider Name (Legal Business Name): ALLEN KESHISHIAN NAMAGERDI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 9TH ST APT 272
CLOVIS CA
93612-1734
US

IV. Provider business mailing address

111 W 9TH ST APT 272
CLOVIS CA
93612-1734
US

V. Phone/Fax

Practice location:
  • Phone: 818-299-6887
  • Fax: 818-299-6887
Mailing address:
  • Phone: 818-299-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberINT35047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: