Provider Demographics
NPI:1235553231
Name:GHATTAS, RIMA
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:
Last Name:GHATTAS
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 1:7369 MILLIKEN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6794
Mailing Address - Country:US
Mailing Address - Phone:909-484-2647
Mailing Address - Fax:909-484-2768
Practice Address - Street 1:7369 MILLIKEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6794
Practice Address - Country:US
Practice Address - Phone:909-484-2647
Practice Address - Fax:909-484-2768
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist