Provider Demographics
NPI:1699294843
Name:NIVARTHI, NIDHI
Entity type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:NIVARTHI
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 1:6522 AMBROSIA DR APT 5308
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3136
Mailing Address - Country:US
Mailing Address - Phone:315-254-5630
Mailing Address - Fax:
Practice Address - Street 1:4445 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3919
Practice Address - Country:US
Practice Address - Phone:858-273-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist