Provider Demographics
NPI:1457768350
Name:MAHMOUD, GAMAL ELDIN HAMED
Entity Type:Individual
Prefix:
First Name:GAMAL
Middle Name:ELDIN HAMED
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GAMAL
Other - Middle Name:ELDIN HAMED
Other - Last Name:MAHMOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2214 EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4602
Mailing Address - Country:US
Mailing Address - Phone:916-922-8752
Mailing Address - Fax:916-929-9670
Practice Address - Street 1:2214 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4602
Practice Address - Country:US
Practice Address - Phone:916-922-8752
Practice Address - Fax:916-929-9670
Is Sole Proprietor?:No
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH49228OtherLICENCE