Provider Demographics
NPI:1760047328
Name:TOMHE-ALSADEK, HALA
Entity Type:Individual
Prefix:
First Name:HALA
Middle Name:
Last Name:TOMHE-ALSADEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PALATINE APT 134
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-7637
Mailing Address - Country:US
Mailing Address - Phone:805-709-6128
Mailing Address - Fax:
Practice Address - Street 1:1322 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3167
Practice Address - Country:US
Practice Address - Phone:951-371-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist