Provider Demographics
NPI:1699399212
Name:SABACKIC, MAKSIDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAKSIDA
Middle Name:
Last Name:SABACKIC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3137
Mailing Address - Country:US
Mailing Address - Phone:617-697-3300
Mailing Address - Fax:
Practice Address - Street 1:19300 S HAMILTON AVE STE 170180
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4400
Practice Address - Country:US
Practice Address - Phone:310-464-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20486183500000X
CARPH79470183500000X
MAPH236088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist