Healthcare Provider Details

I. General information

NPI: 1316458896
Provider Name (Legal Business Name): CHRISTINE AYAD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 JACKSON ST
RIVERSIDE CA
92503-3919
US

IV. Provider business mailing address

6172 LAUREL BLOSSOM PL
RANCHO CUCAMONGA CA
91739-9431
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-5336
  • Fax:
Mailing address:
  • Phone: 909-262-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number59045
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH59045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: