MEDICARE: EMAD ELDIN MAHMOUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH025839	GA
2	183500000X	Pharmacist	054396	NY
3	183500000X	Pharmacist	5302037201	MI
4	183500000X	Pharmacist	51294043	IL
5	183500000X	Pharmacist	RPH 74850	CA

General Provider Information

NPI Number	:	1255643524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMAD ELDIN MAHMOUD

Provider Business Mailing Address
First Line	:	8834 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3302
Country	:	US
Telephone Number	:	213-878-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 W GARDENA BLVD STE A
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-4957
Country	:	US
Telephone Number	:	213-878-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	11/30/2022

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Directions to “ EMAD ELDIN MAHMOUD ” Practice Location

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