Provider Demographics
NPI:1376072983
Name:CHAABAN, ROULA (RPH)
Entity Type:Individual
Prefix:
First Name:ROULA
Middle Name:
Last Name:CHAABAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2011
Mailing Address - Country:US
Mailing Address - Phone:310-828-6456
Mailing Address - Fax:310-829-4375
Practice Address - Street 1:2505 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2011
Practice Address - Country:US
Practice Address - Phone:310-828-6456
Practice Address - Fax:310-829-4375
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist