Provider Demographics
NPI:1871979963
Name:SALIB, MINA KAMAL ANDRAWS
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:KAMAL ANDRAWS
Last Name:SALIB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 N JUNEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-5001
Mailing Address - Country:US
Mailing Address - Phone:714-749-5786
Mailing Address - Fax:
Practice Address - Street 1:3077 N JUNEBERRY ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-5001
Practice Address - Country:US
Practice Address - Phone:714-749-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650791835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy