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General NPI Number Information
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NPI Number | 1669874269
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Entity Type | Individual
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Provider Name | MUTAZ AHMAD RPH
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Gender | Male
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 1225 N HOLMAR AVE
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City | AZUSA
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State | CA
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Zip | 91702-2133
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Country | US
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Telephone | 626-991-1328
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 SAN BERNARDINO RD STE 1100
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City | UPLAND
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State | CA
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Zip | 91786-4952
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Country | US
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Telephone | 626-546-8047
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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 | 71552
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License Number State | CA
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