Provider Demographics
NPI:1538444963
Name:STEWART, NAIDENE
Entity type:Individual
Prefix:
First Name:NAIDENE
Middle Name:
Last Name:STEWART
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 1:1285 S MISSION RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4005
Mailing Address - Country:US
Mailing Address - Phone:760-451-2970
Mailing Address - Fax:760-451-2976
Practice Address - Street 1:1285 S MISSION RD
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4005
Practice Address - Country:US
Practice Address - Phone:760-451-2970
Practice Address - Fax:760-451-2976
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist