Healthcare Provider Details

I. General information

NPI: 1154855294
Provider Name (Legal Business Name): ABDOALI SHAHDAWALA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2017
Last Update Date: 11/17/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839A YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3214
US

IV. Provider business mailing address

1839A YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3214
US

V. Phone/Fax

Practice location:
  • Phone: 925-954-7869
  • Fax: 925-954-7925
Mailing address:
  • Phone: 925-954-7869
  • Fax: 925-954-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: