Provider Demographics
NPI:1215350996
Name:FAIZYAR, SOHAILA
Entity type:Individual
Prefix:
First Name:SOHAILA
Middle Name:
Last Name:FAIZYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10424 TRINITY PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7225
Mailing Address - Country:US
Mailing Address - Phone:209-235-0252
Mailing Address - Fax:
Practice Address - Street 1:10424 TRINITY PKWY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7225
Practice Address - Country:US
Practice Address - Phone:209-235-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist