Provider Demographics
NPI:1144566134
Name:LEBADA, MOHAMED (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:LEBADA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 BRANDING IRON PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2273
Mailing Address - Country:US
Mailing Address - Phone:714-955-8251
Mailing Address - Fax:
Practice Address - Street 1:5146 BRANDING IRON PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2273
Practice Address - Country:US
Practice Address - Phone:714-955-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46945OtherPHARMACIST