Joud Nameh
Individual provider Active NPI Pharmacist · Eagle Rock, CA
NPI 1669124368 · NPPES record last updated Feb 1, 2022
Key facts
- NPI
- 1669124368
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 84306 (CA)
- Practice address
- 1030 Colorado Blvd
Eagle Rock, CA 90041-2502 - Phone
- (323) 255-5130
- NPI assigned
- Jan 24, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 84306 | CA | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 84306 | CA | Yes |
Addresses
Primary practice location
1030 Colorado Blvd
Eagle Rock, CA 90041-2502
Mailing address
1030 Colorado Blvd
Eagle Rock, CA 90041-2502
Phone (626) 524-0121
Other providers in Eagle Rock, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.