Provider Demographics
NPI:1437665288
Name:ELDAHMY, AHMED (PHARMD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ELDAHMY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 NATIONAL AVE STE 1103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-2155
Mailing Address - Country:US
Mailing Address - Phone:619-869-5895
Mailing Address - Fax:619-331-1122
Practice Address - Street 1:1985 NATIONAL AVE STE 1103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2155
Practice Address - Country:US
Practice Address - Phone:619-869-5895
Practice Address - Fax:619-331-1122
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA66936OtherBOARD OF PHARMACY LICENSE