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General NPI Number Information
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NPI Number | 1568206423
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Entity Type | Individual
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Provider Name | KHALED ELDEMERDASH RPH
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Gender | Male
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Dates
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Enumeration Date | 06/24/2024
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 222 W 39TH AVE
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City | SAN MATEO
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State | CA
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Zip | 94403-4364
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Country | US
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Telephone | 650-573-2222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 934
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City | CAMARILLO
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State | CA
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Zip | 93011-0934
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 89376
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License Number State | CA
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