Provider Demographics
NPI:1275800567
Name:RIZKALLA, GEORGE M
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:RIZKALLA
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 1:38957 PALACE DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-7154
Mailing Address - Country:US
Mailing Address - Phone:760-345-8212
Mailing Address - Fax:
Practice Address - Street 1:47900 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2209
Practice Address - Country:US
Practice Address - Phone:760-771-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist