Provider Demographics
NPI:1306194410
Name:ALKAZAKI, USAMA
Entity Type:Individual
Prefix:
First Name:USAMA
Middle Name:
Last Name:ALKAZAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 HORIZON HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1160
Mailing Address - Country:US
Mailing Address - Phone:909-919-0906
Mailing Address - Fax:
Practice Address - Street 1:505 N MOLLISON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-6159
Practice Address - Country:US
Practice Address - Phone:909-919-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10659183500000X
AZS019805183500000X
CA69696183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306194410Medicaid