Provider Demographics
NPI:1467767020
Name:MISSOUMI, MAHA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MAHA
Middle Name:
Last Name:MISSOUMI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4373 COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2837
Mailing Address - Country:US
Mailing Address - Phone:818-766-3234
Mailing Address - Fax:
Practice Address - Street 1:11350 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3631
Practice Address - Country:US
Practice Address - Phone:818-760-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-07
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist