Provider Demographics
NPI:1346853694
Name:SHOKRALLA, FEBEY
Entity Type:Individual
Prefix:
First Name:FEBEY
Middle Name:
Last Name:SHOKRALLA
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 1:50040 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236
Mailing Address - Country:US
Mailing Address - Phone:760-391-5395
Mailing Address - Fax:760-398-6066
Practice Address - Street 1:50040 HARRISON ST
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236
Practice Address - Country:US
Practice Address - Phone:760-391-5395
Practice Address - Fax:760-398-6066
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist