Basic Information
| Provider Information | |||||||||
| NPI: | 1811405426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUIRGUIS | ||||||||
| FirstName: | MICHAIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12003 WALDEN PARK PL | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933119251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189419410 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5625 CALLOWAY DR | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933129726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613687066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 66230 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.