Provider Demographics
NPI:1598163040
Name:ELELIMY, MOHAMED (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:ELELIMY
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 1:4000 SCENIC RIVER LN.
Mailing Address - Street 2:APT#7M
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308
Mailing Address - Country:US
Mailing Address - Phone:732-927-0801
Mailing Address - Fax:
Practice Address - Street 1:2901 MING AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4144
Practice Address - Country:US
Practice Address - Phone:661-617-2001
Practice Address - Fax:661-617-2002
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65483OtherCALIFORNIA BOARD OF PHARMACY