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General NPI Number Information
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NPI Number | 1134606767
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Entity Type | Organization
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Legal Business Name | NASIBADARA, INC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 23665 MOULTON PKWY STE B
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1937
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Country | US
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Telephone | 949-586-3664
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Fax | 949-580-1723
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Provider Business Mailing Address
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Address Line | 23665 MOULTON PKWY STE B
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1937
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Country | US
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Telephone | 949-586-3664
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Fax | 949-580-1723
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. STEWART EDINGTON
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Credential |
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Telephone | 954-818-6813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY55801
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License Number State | CA
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