Provider Demographics
NPI:1962166967
Name:AHMADYAR, ZAFARUDDIN
Entity type:Individual
Prefix:
First Name:ZAFARUDDIN
Middle Name:
Last Name:AHMADYAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 LA CUMBRE ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-5856
Mailing Address - Country:US
Mailing Address - Phone:951-315-0747
Mailing Address - Fax:
Practice Address - Street 1:1800 N PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2701
Practice Address - Country:US
Practice Address - Phone:951-940-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist