Provider Demographics
NPI:1649571845
Name:WASSEF, MAGDOLINE J (RPH)
Entity Type:Individual
Prefix:
First Name:MAGDOLINE
Middle Name:J
Last Name:WASSEF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2211
Mailing Address - Country:US
Mailing Address - Phone:925-634-6782
Mailing Address - Fax:
Practice Address - Street 1:1125 2ED ST,
Practice Address - Street 2:
Practice Address - City:BRENTWOODE
Practice Address - State:CA
Practice Address - Zip Code:94513
Practice Address - Country:US
Practice Address - Phone:925-634-6782
Practice Address - Fax:925-634-6795
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist