Provider Demographics
NPI:1447995865
Name:NASR, MINA
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:NASR
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 1:5660 SONOMA DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7721
Mailing Address - Country:US
Mailing Address - Phone:925-393-8137
Mailing Address - Fax:
Practice Address - Street 1:5660 SONOMA DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7721
Practice Address - Country:US
Practice Address - Phone:925-393-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA783151835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
99108504OtherBOARD CERTIFIED GERIATRIC PHARMACIST