Healthcare Provider Details

I. General information

NPI: 1093051724
Provider Name (Legal Business Name): GHADEER YACOUB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16930 PARTHENIA ST RITE AID PHARMACY
NORTHRIDGE CA
91343
US

IV. Provider business mailing address

16930 PARTHENIA ST RITE AID PHARMACY
NORTHRIDGE CA
91343
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-2724
  • Fax:
Mailing address:
  • Phone: 818-895-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49332
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12962
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: