Provider Demographics
NPI:1255643524
Name:MAHMOUD, EMAD ELDIN
Entity type:Individual
Prefix:
First Name:EMAD ELDIN
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8834 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3302
Mailing Address - Country:US
Mailing Address - Phone:213-878-1200
Mailing Address - Fax:
Practice Address - Street 1:1049 W GARDENA BLVD STE A
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4957
Practice Address - Country:US
Practice Address - Phone:213-878-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025839183500000X
NY054396183500000X
MI5302037201183500000X
IL51294043183500000X
CARPH 74850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist