Provider Demographics
NPI:1437628294
Name:ELDHSHOURY, ADAM (RPH)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ELDHSHOURY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:AHMED
Other - Middle Name:
Other - Last Name:ELDHSHOURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1467 BALHAN DR APT 107
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3754
Mailing Address - Country:US
Mailing Address - Phone:415-695-4863
Mailing Address - Fax:
Practice Address - Street 1:26059 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2538
Practice Address - Country:US
Practice Address - Phone:510-886-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty