Provider Demographics
NPI:1346709086
Name:ALDAHER, YOUSSEF
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:
Last Name:ALDAHER
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 1:1224 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3521
Mailing Address - Country:US
Mailing Address - Phone:415-864-9164
Mailing Address - Fax:
Practice Address - Street 1:3232 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3113
Practice Address - Country:US
Practice Address - Phone:415-864-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist