Provider Demographics
NPI:1770166787
Name:SAFIE, MOHAMMAD MUSTAFA (PHARM D)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MUSTAFA
Last Name:SAFIE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:MUSTAFA
Other - Middle Name:
Other - Last Name:SAFIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:45870 LA CRUZ DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3938
Mailing Address - Country:US
Mailing Address - Phone:909-489-3633
Mailing Address - Fax:
Practice Address - Street 1:260 N SANDERSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3614
Practice Address - Country:US
Practice Address - Phone:951-658-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist