Provider Demographics
NPI:1407104755
Name:SAMUEL, SHERIF SHOKRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHERIF
Middle Name:SHOKRY
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:SHERIF
Other - Middle Name:S
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2157 MONTEVERDE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4447
Mailing Address - Country:US
Mailing Address - Phone:909-548-4166
Mailing Address - Fax:
Practice Address - Street 1:300 S DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1607
Practice Address - Country:US
Practice Address - Phone:909-861-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist