Healthcare Provider Details

I. General information

NPI: 1770051534
Provider Name (Legal Business Name): SHAIDA ABBAS PHARMD, APP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 HARBOR BLVD STE C1
COSTA MESA CA
92626-1518
US

IV. Provider business mailing address

3303 HARBOR BLVD STE C1
COSTA MESA CA
92626-1518
US

V. Phone/Fax

Practice location:
  • Phone: 267-391-6764
  • Fax:
Mailing address:
  • Phone: 949-996-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number79870
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number79870
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number79870
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number79870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: