Healthcare Provider Details

I. General information

NPI: 1215022090
Provider Name (Legal Business Name): CHADI ABDUL NOUR R.PH , APH, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WILLOWBROOK LN
PHILLIPS RANCH CA
91766-4852
US

IV. Provider business mailing address

42 WILLOWBROOK LN
PHILLIPS RANCH CA
91766-4852
US

V. Phone/Fax

Practice location:
  • Phone: 626-827-2835
  • Fax: 626-261-4450
Mailing address:
  • Phone: 626-827-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: