Healthcare Provider Details

I. General information

NPI: 1164579629
Provider Name (Legal Business Name): NASER MANSOUR QABAZARD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY KAISER PERMANENTE
SANTA ROSA CA
95403
US

IV. Provider business mailing address

401 BICENTENNIAL WAY KAISER PERMANENTE, IN-PATIENT HOSPITAL PHARMACY
SANTA ROSA CA
95403-0167
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-4700
  • Fax: 707-571-4701
Mailing address:
  • Phone: 707-571-4700
  • Fax: 707-571-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number59152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: