Healthcare Provider Details

I. General information

NPI: 1649132366
Provider Name (Legal Business Name): MARVY HANY LOUZ MAHROUS MIKHAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7878 CRESCENT AVE
BUENA PARK CA
90620-3950
US

IV. Provider business mailing address

7878 CRESCENT AVE
BUENA PARK CA
90620-3950
US

V. Phone/Fax

Practice location:
  • Phone: 714-226-0238
  • Fax:
Mailing address:
  • Phone: 714-226-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: