Provider Demographics
NPI:1841823119
Name:GIRGIS, MINA WADIE ISHAK (PHARM D)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:WADIE ISHAK
Last Name:GIRGIS
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 1:17332 SUMMIT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-3196
Mailing Address - Country:US
Mailing Address - Phone:818-454-7671
Mailing Address - Fax:
Practice Address - Street 1:16642 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-3217
Practice Address - Country:US
Practice Address - Phone:661-252-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist