Healthcare Provider Details

I. General information

NPI: 1881579159
Provider Name (Legal Business Name): NEEMAH YAMIN-ESFANDIARY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W TEFFT ST
NIPOMO CA
93444-9187
US

IV. Provider business mailing address

5315 EDNA RANCH CIR
SAN LUIS OBISPO CA
93401-7957
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-2740
  • Fax:
Mailing address:
  • Phone: 310-666-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61203
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: