Provider Demographics
NPI:1568729044
Name:DEMIAN, SALLY MAGDY NASHED (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:MAGDY NASHED
Last Name:DEMIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15851 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7608
Mailing Address - Country:US
Mailing Address - Phone:714-855-9312
Mailing Address - Fax:
Practice Address - Street 1:1240 N HACIENDA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1663
Practice Address - Country:US
Practice Address - Phone:626-918-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist