Provider Demographics
NPI:1316270812
Name:AHDOOT, SHARONA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHARONA
Middle Name:
Last Name:AHDOOT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SANGALLO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5330
Mailing Address - Country:US
Mailing Address - Phone:949-294-2213
Mailing Address - Fax:949-453-1175
Practice Address - Street 1:16300 SAND CANYON AVE STE 301
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3703
Practice Address - Country:US
Practice Address - Phone:949-453-1173
Practice Address - Fax:949-453-1175
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH46351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH46351OtherPHARMACIST LISCENSE#