Provider Demographics
NPI:1740746569
Name:MEGALLAA, MINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:MEGALLAA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 RESERVATION RD
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3178
Mailing Address - Country:US
Mailing Address - Phone:831-384-1605
Mailing Address - Fax:831-384-9662
Practice Address - Street 1:268 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3178
Practice Address - Country:US
Practice Address - Phone:831-384-1605
Practice Address - Fax:831-384-9662
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist