Healthcare Provider Details

I. General information

NPI: 1790541209
Provider Name (Legal Business Name): MARIAM GUIRGUIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 TELEGRAPH AVE
BERKELEY CA
94704-3323
US

IV. Provider business mailing address

4424 WINTERBERRY CT
CONCORD CA
94521-4333
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-9063
  • Fax:
Mailing address:
  • Phone: 925-330-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: