MEDICARE: SHADI HADDADIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	74040	CA

General Provider Information

NPI Number	:	1033582143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADI HADDADIN

Provider Business Mailing Address
First Line	:	1030 QUAIL RUN WAY
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-6280
Country	:	US
Telephone Number	:	312-890-9027
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 VICTORIA AVE
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-2141
Country	:	US
Telephone Number	:	805-985-2326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	11/11/2015

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Directions to “ SHADI HADDADIN ” Practice Location

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