Provider Demographics
NPI:1124614151
Name:BEDAIR, AYA ABBAS (PHARMACIST RPH)
Entity type:Individual
Prefix:
First Name:AYA
Middle Name:ABBAS
Last Name:BEDAIR
Suffix:
Gender:F
Credentials:PHARMACIST RPH
Other - Prefix:
Other - First Name:AYA
Other - Middle Name:ASSEM OMAR KHATAB
Other - Last Name:ABBAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-1417
Mailing Address - Country:US
Mailing Address - Phone:619-691-0873
Mailing Address - Fax:
Practice Address - Street 1:75 N BROADWAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1417
Practice Address - Country:US
Practice Address - Phone:619-691-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA827113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA82711OtherCALIFORNIA BOARD OF PHARMACY