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General NPI Number Information
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NPI Number | 1306619994
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Entity Type | Individual
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Provider Name | AFZAL NADVI
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Gender | Male
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 23975 IRONWOOD AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92557-7153
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Country | US
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Telephone | 951-242-1742
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Fax |
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Provider Business Mailing Address
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Address Line | 6548 N RYAN LN
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-1938
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Country | US
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Telephone | 909-583-4769
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 88756
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License Number State | CA
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