Healthcare Provider Details

I. General information

NPI: 1952647489
Provider Name (Legal Business Name): MICHAEL EDWARD MILAD TADROS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10237 MAGNOLIA AVE
RIVERSIDE CA
92503-3440
US

IV. Provider business mailing address

2494 DAKIN DR
CORONA CA
92882-6193
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-9277
  • Fax: 951-509-9288
Mailing address:
  • Phone: 626-234-3186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: