Provider Demographics
NPI:1558853127
Name:AWAD, MARC
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:AWAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W HARVARD BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3874
Mailing Address - Country:US
Mailing Address - Phone:818-933-1462
Mailing Address - Fax:
Practice Address - Street 1:110 W HARVARD BLVD STE H
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3874
Practice Address - Country:US
Practice Address - Phone:818-933-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790783447OtherPHARMACY