Provider Demographics
NPI:1124560321
Name:SAAD, SHADY TAREK YOUSSEF (RPH)
Entity Type:Individual
Prefix:
First Name:SHADY
Middle Name:TAREK YOUSSEF
Last Name:SAAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8044 LIMONITE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6107
Mailing Address - Country:US
Mailing Address - Phone:951-685-0139
Mailing Address - Fax:
Practice Address - Street 1:8044 LIMONITE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-6107
Practice Address - Country:US
Practice Address - Phone:951-685-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-06
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH74969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist