Healthcare Provider Details

I. General information

NPI: 1952999310
Provider Name (Legal Business Name): NADER MAGDY ANWAR YACOUB RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 07/29/2021
Certification Date: 07/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 DISTRICT BLVD UNIT 200
BAKERSFIELD CA
93313-2148
US

IV. Provider business mailing address

8201 CAMINO MEDIA APT 189
BAKERSFIELD CA
93311-2017
US

V. Phone/Fax

Practice location:
  • Phone: 661-615-6000
  • Fax:
Mailing address:
  • Phone: 562-568-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: