Provider Demographics
NPI:1417141540
Name:TABIKH, MAYSOON M (RPH, CDM)
Entity Type:Individual
Prefix:MRS
First Name:MAYSOON
Middle Name:M
Last Name:TABIKH
Suffix:
Gender:F
Credentials:RPH, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 FREEDOM WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7047
Mailing Address - Country:US
Mailing Address - Phone:760-598-4829
Mailing Address - Fax:760-598-4829
Practice Address - Street 1:2067 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7047
Practice Address - Country:US
Practice Address - Phone:760-598-4829
Practice Address - Fax:760-598-4829
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 44828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist