Provider Demographics
NPI:1144726142
Name:NAMIQ, ROUSL
Entity type:Individual
Prefix:
First Name:ROUSL
Middle Name:
Last Name:NAMIQ
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 1:2939 ALTA VIEW DR STE L
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3394
Mailing Address - Country:US
Mailing Address - Phone:619-470-4550
Mailing Address - Fax:619-470-6709
Practice Address - Street 1:2939 ALTA VIEW DR STE L
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3394
Practice Address - Country:US
Practice Address - Phone:619-470-4550
Practice Address - Fax:619-470-6709
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH72775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist