Provider Demographics
NPI:1083203087
Name:MOSSAAD, FARIDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:FARIDA
Middle Name:
Last Name:MOSSAAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:FARIDA
Other - Middle Name:AMR
Other - Last Name:MOSSAAD-AHMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:243 SEACOUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5564
Mailing Address - Country:US
Mailing Address - Phone:949-975-9258
Mailing Address - Fax:
Practice Address - Street 1:9701 JERONIMO RD STE 300
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2076
Practice Address - Country:US
Practice Address - Phone:800-960-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist