Provider Demographics
NPI:1447658562
Name:YOUSIP, SARGON (PHARMD)
Entity type:Individual
Prefix:
First Name:SARGON
Middle Name:
Last Name:YOUSIP
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2145
Mailing Address - Country:US
Mailing Address - Phone:209-541-0471
Mailing Address - Fax:209-541-0501
Practice Address - Street 1:1670 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2145
Practice Address - Country:US
Practice Address - Phone:209-541-0471
Practice Address - Fax:209-541-0501
Is Sole Proprietor?:No
Enumeration Date:2014-12-06
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist