Provider Demographics
NPI:1558077719
Name:BEYDOUN, MARY ROBERT (RPH)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROBERT
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 14TH ST UNIT 442
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7594
Mailing Address - Country:US
Mailing Address - Phone:313-701-2261
Mailing Address - Fax:
Practice Address - Street 1:699 14TH ST UNIT 442
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7594
Practice Address - Country:US
Practice Address - Phone:313-701-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist