Healthcare Provider Details

I. General information

NPI: 1861759326
Provider Name (Legal Business Name): MIRETTE GIRGIS FOUAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 SPRING RD
MOORPARK CA
93021-2300
US

IV. Provider business mailing address

3941 SPRING RD
MOORPARK CA
93021-2300
US

V. Phone/Fax

Practice location:
  • Phone: 805-529-5726
  • Fax: 805-529-8533
Mailing address:
  • Phone: 805-529-5726
  • Fax: 805-529-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: