Provider Demographics
NPI:1861759326
Name:FOUAD, MIRETTE GIRGIS
Entity type:Individual
Prefix:
First Name:MIRETTE
Middle Name:GIRGIS
Last Name:FOUAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2300
Mailing Address - Country:US
Mailing Address - Phone:805-529-5726
Mailing Address - Fax:805-529-8533
Practice Address - Street 1:3941 SPRING RD
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2300
Practice Address - Country:US
Practice Address - Phone:805-529-5726
Practice Address - Fax:805-529-8533
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist