Provider Demographics
NPI:1912525783
Name:MEGALLA, ENASS FOUAD
Entity Type:Individual
Prefix:
First Name:ENASS
Middle Name:FOUAD
Last Name:MEGALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3236
Mailing Address - Country:US
Mailing Address - Phone:626-966-8497
Mailing Address - Fax:626-966-3161
Practice Address - Street 1:150 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3236
Practice Address - Country:US
Practice Address - Phone:626-966-8497
Practice Address - Fax:626-966-3161
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist