Provider Demographics
NPI:1124560321
Name:SAAD, SHADY TAREK YOUSSEF (RPH)
Entity type:Individual
Prefix:
First Name:SHADY
Middle Name:TAREK YOUSSEF
Last Name:SAAD
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 1:100 W ONTARIO AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-5215
Mailing Address - Country:US
Mailing Address - Phone:951-582-9551
Mailing Address - Fax:951-493-6762
Practice Address - Street 1:100 W ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-5215
Practice Address - Country:US
Practice Address - Phone:951-685-0139
Practice Address - Fax:951-493-6762
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-06
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH74969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist