Provider Demographics
NPI:1932795986
Name:BEDAIR, KHALED MAHMOUD SAFWAT
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:MAHMOUD SAFWAT
Last Name:BEDAIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KHALED
Other - Middle Name:MAHMOUD SAFWAT
Other - Last Name:MAHMOUD BEDAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 SATURN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 SATURN BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4731
Practice Address - Country:US
Practice Address - Phone:619-205-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA835853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA83585OtherCALIFORNIA BOARD OF PHARMACY