Individual provider Active NPI

Gamal Demian Abdelmalak

  • Pharmacist
  • Hesperia, CA
National Provider Identifier
1114606852
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
44846 Issued in CA
Practice address
11919 Hesperia Rd # Sutc
Hesperia, CA 92345-2158
Phone
(760) 244-3777
NPI assigned
Jul 11, 2023
Last updated
Jul 11, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 44846 CA Primary

Addresses

Primary practice location

11919 Hesperia Rd # Sutc
Hesperia, CA 92345-2158

Mailing address

3905 Coolidge Ave
Los Angeles, CA 90066-5007
Phone (310) 391-2030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
44846CAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1114606852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 COOLIDGE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900665007",
            "telephone_number": "310-391-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11919 HESPERIA RD # SUTC",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923452158",
            "telephone_number": "760-244-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDELMALAK",
        "first_name": "GAMAL",
        "middle_name": "DEMIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "44846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hesperia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.