Provider Demographics
NPI:1508067604
Name:BAHOU, ELIE M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ELIE
Middle Name:M
Last Name:BAHOU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 S MOUNTVALE CT
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2108
Mailing Address - Country:US
Mailing Address - Phone:714-357-5936
Mailing Address - Fax:714-533-1812
Practice Address - Street 1:1035 S MOUNTVALE CT
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2108
Practice Address - Country:US
Practice Address - Phone:714-357-5936
Practice Address - Fax:714-533-1812
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist