Active NPI
Shady Wassef
- Pharmacist
- Covina, CA
National Provider Identifier
1174178842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 76172
- Practice address
- 1010 E Arrow Hwy
Covina, CA 91724-1020 - Phone
- (626) 209-8169
- Fax
- (626) 209-8171
- NPI assigned
- Aug 8, 2019
- Last updated
- Aug 8, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 76172 | CA | Primary |
Addresses
Primary practice location
1010 E Arrow Hwy
Covina, CA 91724-1020
Mailing address
71 San Angelo
Rancho Santa Margarita, CA 92688-2417
Phone (949) 245-9956
Other practice location 1
71 San Angelo
Rancho Santa Margarita, CA 92688-2417
Phone (949) 245-9956 ext. 94924
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
| License | State | Type | Specialty |
|---|---|---|---|
| 76172 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Goodsamhealth Inc | Current | Accepting new patients | |
| Goodsamhealth Inc | Pharmacist | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565222400000",
"number": "1174178842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 SAN ANGELO",
"city": "RANCHO SANTA MARGARITA",
"state": "CA",
"postal_code": "926882417",
"telephone_number": "949-245-9956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 E ARROW HWY",
"city": "COVINA",
"state": "CA",
"postal_code": "917241020",
"telephone_number": "626-209-8169",
"fax_number": "626-209-8171"
}
],
"practiceLocations": [
{
"address_1": "71 San Angelo",
"address_purpose": "LOCATION",
"city": "Rancho Santa Margarita",
"state": "CA",
"postal_code": "926882417",
"country_code": "US",
"telephone_number": "949-245-9956 x94924",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WASSEF",
"first_name": "SHADY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-08",
"last_updated": "2019-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "76172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.