Provider Demographics
NPI:1720357296
Name:HAG, AHMED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:HAG
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 1:46208 TIMBERMINE LN
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4132
Mailing Address - Country:US
Mailing Address - Phone:216-258-6366
Mailing Address - Fax:
Practice Address - Street 1:1661 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3818
Practice Address - Country:US
Practice Address - Phone:951-929-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59228183500000X
OH03127300183500000X
AZS015842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist