Provider Demographics
NPI:1477766012
Name:LEBADA, MAHMUD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MAHMUD
Middle Name:
Last Name:LEBADA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 BRENNEN WAY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4217
Mailing Address - Country:US
Mailing Address - Phone:714-334-8952
Mailing Address - Fax:714-517-0400
Practice Address - Street 1:2530 BRENNEN WAY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4217
Practice Address - Country:US
Practice Address - Phone:714-334-8952
Practice Address - Fax:714-517-0400
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist