Provider Demographics
NPI:1962886853
Name:BADR, AISHA
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:BADR
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 1:1925 W RIVER RD
Mailing Address - Street 2:UNIT 4303
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1925 W RIVER RD
Practice Address - Street 2:UNIT 4303
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1464
Practice Address - Country:US
Practice Address - Phone:508-315-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist