MEDICARE: MRS. SALLY MAGDY NASHED DEMIAN PH.D

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	64473	CA

General Provider Information

NPI Number	:	1568729044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY MAGDY NASHED DEMIAN PH.D

Provider Business Mailing Address
First Line	:	15851 MONROE ST
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-7608
Country	:	US
Telephone Number	:	714-855-9312
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 N HACIENDA BLVD STE 105
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-1663
Country	:	US
Telephone Number	:	626-918-4300
Fax Number	:

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

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/20/2012

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