Azadeh Nakisa, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

83770 Issued in CA

Practice address

CVS Pharmacy, 291 N McDowell Blvd
291 N McDowell Blvd
Petaluma, CA 94954

Phone

(707) 778-8666

NPI assigned

Jun 15, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Longs Drug Stores California LLC

  • Pharmacy
  • Petaluma, CA
  • NPI 1952344129
  NPD (past)
• Longs Drug Store California LLC

  • Pharmacy
  • Kapolei, HI
  • NPI 1700565793
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1407424476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CVS PHARMACY, 291 N MCDOWELL BLVD",
            "address_2": "291 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "94954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CVS PHARMACY, 291 N MCDOWELL BLVD",
            "address_2": "291 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "94954",
            "telephone_number": "707-778-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAKISA",
        "first_name": "AZADEH",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "83770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Morean Nackord, MA
• Stephen H Nagle
• Monica Renee Najera
• Ashley Shizu Nakagawa, MS, RD
• Hiromi Nakajima, DIETITIAN
• Crystle Nancovski
• Georgette Naron
• Mahdad Nassiri, D.D.S
• National Vision, Inc.
• Shannon Renee Navarro, MFTI

• Pharmacist in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.