Provider Demographics
NPI:1265783377
Name:AL-AGHA, OUSAMA (PHARM D)
Entity type:Individual
Prefix:MR
First Name:OUSAMA
Middle Name:
Last Name:AL-AGHA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 TRILLIUM WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2935
Mailing Address - Country:US
Mailing Address - Phone:858-271-8855
Mailing Address - Fax:
Practice Address - Street 1:11350 TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2935
Practice Address - Country:US
Practice Address - Phone:858-271-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1410Medicaid