Provider Demographics
NPI:1235411455
Name:MITRY, SHIRIF WAGIEH (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:SHIRIF
Middle Name:WAGIEH
Last Name:MITRY
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E DUARTE RD STE D
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6691
Mailing Address - Country:US
Mailing Address - Phone:626-317-5052
Mailing Address - Fax:626-317-5091
Practice Address - Street 1:145 E DUARTE RD STE D
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6691
Practice Address - Country:US
Practice Address - Phone:626-317-5052
Practice Address - Fax:626-317-5091
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205746183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist