Provider Demographics
NPI:1780984146
Name:GHATTAS, NAZMY B (PHARMACIST)
Entity type:Individual
Prefix:
First Name:NAZMY
Middle Name:B
Last Name:GHATTAS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7390 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4204
Mailing Address - Country:US
Mailing Address - Phone:909-429-3933
Mailing Address - Fax:909-429-3939
Practice Address - Street 1:7390 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4204
Practice Address - Country:US
Practice Address - Phone:909-429-3933
Practice Address - Fax:909-429-3939
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist