Mariam Medhat Fahim
Individual provider Active NPI Pharmacist · Vandenberg Afb, CA
NPI 1801548334 · NPPES record last updated Sep 20, 2022
Key facts
- NPI
- 1801548334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 85654 (CA)
- Practice address
- 338 S Dakota Ave
Vandenberg Afb, CA 93437-6307 - Phone
- (805) 606-2273
- NPI assigned
- Jan 26, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 85654 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 85654 | CA | Yes |
Addresses
Primary practice location
338 S Dakota Ave
Vandenberg Afb, CA 93437-6307
Mailing address
2521 Eastbluff Dr
Newport Beach, CA 92660-3504
Other practice location 1
2521 Eastbluff Dr
Newport Beach, CA 92660-3504
Phone (949) 717-6642
Other providers in Vandenberg Afb, CA
- Benjamin Paul Crandall
- Luke Robert Creasman
- Felipa Alcoreza Dacanay
- Jared Alan Detter
- Jana Kristin San Jose Dionisio
- Rachael Faye Fields
- Nathaniel James Goetz
- Alecia Hagman
- Jennifer H Harris
- Health and Wellness Center
All providers in Vandenberg Afb, CA · Pharmacist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 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.