Provider Demographics
NPI:1174978407
Name:MOSAAD, FADY (RPH)
Entity type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:MOSAAD
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 1:174 S SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6737
Mailing Address - Country:US
Mailing Address - Phone:760-778-8870
Mailing Address - Fax:760-778-8850
Practice Address - Street 1:174 S SUNRISE WAY
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6737
Practice Address - Country:US
Practice Address - Phone:760-778-8870
Practice Address - Fax:760-778-8850
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-23
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist