Provider Demographics
NPI:1578847745
Name:ABOU-EL-SEOUD, AHMED M (RPH)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:M
Last Name:ABOU-EL-SEOUD
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 1:3905 LA SIERRA AVE APT 58
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3543
Mailing Address - Country:US
Mailing Address - Phone:951-756-8374
Mailing Address - Fax:
Practice Address - Street 1:21650 OUTER HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-3990
Practice Address - Country:US
Practice Address - Phone:760-240-0866
Practice Address - Fax:760-961-9488
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist