Provider Demographics
NPI:1700421351
Name:JAWAD, NASRY KAREEM
Entity Type:Individual
Prefix:
First Name:NASRY
Middle Name:KAREEM
Last Name:JAWAD
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 1:1749 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2913
Mailing Address - Country:US
Mailing Address - Phone:909-326-1526
Mailing Address - Fax:
Practice Address - Street 1:10 BELL VIS
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1832
Practice Address - Country:US
Practice Address - Phone:949-293-9834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist