Mutaz Ahmad, RPH
Individual provider Active NPI Pharmacist · Azusa, CA
NPI 1669874269 · NPPES record last updated Oct 27, 2021
Key facts
- NPI
- 1669874269
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 71552 (CA)
- Practice address
- 1225 N Holmar Ave
Azusa, CA 91702-2133 - Phone
- (626) 991-1328
- NPI assigned
- Sep 25, 2014
- 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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71552 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 71552 | CA | Yes |
Addresses
Primary practice location
1225 N Holmar Ave
Azusa, CA 91702-2133
Mailing address
1100 San Bernardino Rd Ste 1100
Upland, CA 91786-4952
Phone (626) 546-8047
Other providers in Azusa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2021. 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.