Provider Demographics
NPI:1639607856
Name:ABBAS, AHMED MOHAMED MOHAMED S
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:MOHAMED MOHAMED S
Last Name:ABBAS
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 1:2006 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5913
Mailing Address - Country:US
Mailing Address - Phone:661-945-2729
Mailing Address - Fax:661-949-7022
Practice Address - Street 1:2006 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-5913
Practice Address - Country:US
Practice Address - Phone:661-945-2729
Practice Address - Fax:661-949-7022
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist