Provider Demographics
NPI:1003374554
Name:ELDAHMY WELLNESS PHARMACY INC.
Entity Type:Organization
Organization Name:ELDAHMY WELLNESS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:619-869-5895
Mailing Address - Street 1:1985 NATIONAL AVE STE 1103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-2155
Mailing Address - Country:US
Mailing Address - Phone:619-331-1111
Mailing Address - Fax:
Practice Address - Street 1:1985 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2154
Practice Address - Country:US
Practice Address - Phone:619-331-1111
Practice Address - Fax:619-331-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11841339834Medicaid