MEDICARE: KAMEL FARAGALLAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	76435	CA

General Provider Information

NPI Number	:	1548776651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMEL FARAGALLAH

Provider Business Mailing Address
First Line	:	3922 COCHRAN ST UNIT 25
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-2333
Country	:	US
Telephone Number	:	805-551-3884
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 VICTORIA AVE
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-2141
Country	:	US
Telephone Number	:	805-985-2326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2017
Last Update Date	:	12/27/2017

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Directions to “ KAMEL FARAGALLAH ” Practice Location

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