Provider Demographics
NPI:1790541209
Name:GUIRGUIS, MARIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:GUIRGUIS
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 1:4424 WINTERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4333
Mailing Address - Country:US
Mailing Address - Phone:925-330-8418
Mailing Address - Fax:
Practice Address - Street 1:2655 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3323
Practice Address - Country:US
Practice Address - Phone:510-549-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist