Provider Demographics
NPI:1265717748
Name:GERGES, LIDIA NADER (RPH)
Entity type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:NADER
Last Name:GERGES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 DANDELION LN
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5565
Mailing Address - Country:US
Mailing Address - Phone:925-718-5330
Mailing Address - Fax:925-718-5330
Practice Address - Street 1:3655 ALHAMBRA AVE
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3912
Practice Address - Country:US
Practice Address - Phone:925-372-0337
Practice Address - Fax:925-372-6018
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59350OtherRPH LICENSE#