MEDICARE: YAMAM ALDAKKAK RPH

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	87152	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87152	OTHER	CA	RPH LICENSE NO.

General Provider Information

NPI Number	:	1831896687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMAM ALDAKKAK RPH

Provider Business Mailing Address
First Line	:	2810 S TRACY BLVD
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95377-8127
Country	:	US
Telephone Number	:	951-824-4487
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 W 11TH ST
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95376-3736
Country	:	US
Telephone Number	:	209-832-1498
Fax Number	:

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

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	02/13/2023

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