Provider Demographics
NPI:1134435670
Name:SALAMA, MAGED RAGAIE AZIZ
Entity type:Individual
Prefix:
First Name:MAGED
Middle Name:RAGAIE AZIZ
Last Name:SALAMA
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 1:2354 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:#58
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7025
Mailing Address - Country:US
Mailing Address - Phone:909-720-2399
Mailing Address - Fax:
Practice Address - Street 1:12900 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-4567
Practice Address - Country:US
Practice Address - Phone:760-251-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist