Provider Demographics
NPI:1477092609
Name:GHONIM, SHERYL CHONG (RPH)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:CHONG
Last Name:GHONIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:SHERYL
Other - Middle Name:M
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6631 RUBY GIANT CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9148
Mailing Address - Country:US
Mailing Address - Phone:714-864-1370
Mailing Address - Fax:
Practice Address - Street 1:6631 RUBY GIANT CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-9148
Practice Address - Country:US
Practice Address - Phone:714-864-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist