Provider Demographics
NPI:1962571323
Name:YOUAKIM, EMAD (RPH)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:YOUAKIM
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 1:19210 CHESTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4188
Mailing Address - Country:US
Mailing Address - Phone:626-964-5158
Mailing Address - Fax:626-962-1157
Practice Address - Street 1:401 N VINCENT AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3907
Practice Address - Country:US
Practice Address - Phone:626-962-1061
Practice Address - Fax:626-962-1157
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56563OtherRPH LICENSE #