Provider Demographics
NPI:1336424647
Name:ELGENDY, WAGIH SAMY (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:WAGIH
Middle Name:SAMY
Last Name:ELGENDY
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 1:1032 BLUE BIRD LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1780
Mailing Address - Country:US
Mailing Address - Phone:650-888-8847
Mailing Address - Fax:
Practice Address - Street 1:3416 DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6650
Practice Address - Country:US
Practice Address - Phone:925-978-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH55602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH55602OtherCALIFORNIA STATE LICENSE NUMBER