Individual
FAHAD ISLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1183 MAGNOLIA AVE, CORONA, CA 92879-3231
(951) 272-4427
(951) 272-1585
Mailing address
24459 PRESTON CT, LAKE ELSINORE, CA 92532-2747
(954) 682-0003
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
76582
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
76582
CALIFORNIA BOARD OF PHARMACY
CA
Enumeration date
04/09/2018
Last updated
04/09/2018
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