Provider Demographics
NPI:1124303862
Name:MAMANE, AHMED (RPH)
Entity type:Individual
Prefix:MR
First Name:AHMED
Middle Name:
Last Name:MAMANE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WALNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5280
Mailing Address - Country:US
Mailing Address - Phone:530-592-3917
Mailing Address - Fax:530-809-1936
Practice Address - Street 1:230 WALNUT ST STE B
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5280
Practice Address - Country:US
Practice Address - Phone:530-592-3917
Practice Address - Fax:530-809-1936
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist