Provider Demographics
NPI:1902573157
Name:CHAICHI, ADNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADNA
Middle Name:
Last Name:CHAICHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FOREST PARK BLVD APT 225A
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-5520
Mailing Address - Country:US
Mailing Address - Phone:949-351-4529
Mailing Address - Fax:
Practice Address - Street 1:1739 S VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6503
Practice Address - Country:US
Practice Address - Phone:805-665-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84620333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy