Provider Demographics
NPI:1285338095
Name:FAHMY, MINA FAHMY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:FAHMY
Last Name:FAHMY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 AVENIDA DE AUTLAN
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7472
Mailing Address - Country:US
Mailing Address - Phone:805-218-6848
Mailing Address - Fax:
Practice Address - Street 1:2902 AVENIDA DE AUTLAN
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7472
Practice Address - Country:US
Practice Address - Phone:805-218-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist