Healthcare Provider Details

I. General information

NPI: 1275360059
Provider Name (Legal Business Name): RAMEZ MICHAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12058 PALMDALE RD
ADELANTO CA
92301-6708
US

IV. Provider business mailing address

12681 CAMBRIA DR
RANCHO CUCAMONGA CA
91739-2383
US

V. Phone/Fax

Practice location:
  • Phone: 760-246-2803
  • Fax:
Mailing address:
  • Phone: 909-201-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: