Provider Demographics
NPI:1619719556
Name:ABD WAHAB, ENAS SARMED (RPH)
Entity type:Individual
Prefix:
First Name:ENAS
Middle Name:SARMED
Last Name:ABD WAHAB
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 1:12190 CUYAMACA COLLEGE DR E UNIT 908
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4313
Mailing Address - Country:US
Mailing Address - Phone:858-257-7000
Mailing Address - Fax:
Practice Address - Street 1:528 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4008
Practice Address - Country:US
Practice Address - Phone:619-605-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH88145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist