MEDICARE: GAMAL ELDIN HAMED 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	RPH49228	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH49228	OTHER	CA	LICENCE

General Provider Information

NPI Number	:	1457768350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAMAL ELDIN HAMED MAHMOUD

Provider Business Mailing Address
First Line	:	2214 EL CAMINO AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-4602
Country	:	US
Telephone Number	:	916-922-8752
Fax Number	:	916-929-9670

Provider Business Practice Location Address
First Line	:	2214 EL CAMINO AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-4602
Country	:	US
Telephone Number	:	916-922-8752
Fax Number	:	916-929-9670

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

Provider Enumeration Date	:	07/13/2014
Last Update Date	:	07/13/2014

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