Provider Demographics
NPI:1487120887
Name:GHATTAS, MARGO NASRY MAHROUS
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:NASRY MAHROUS
Last Name:GHATTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5045 VALLEY CREST DR APT 210
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4902
Mailing Address - Country:US
Mailing Address - Phone:925-393-8136
Mailing Address - Fax:
Practice Address - Street 1:2900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2035
Practice Address - Country:US
Practice Address - Phone:925-933-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist