Provider Demographics
NPI:1568938785
Name:BARRAQUIAS, GEMINESSE (RPH)
Entity Type:Individual
Prefix:
First Name:GEMINESSE
Middle Name:
Last Name:BARRAQUIAS
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 1:10670 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7421
Mailing Address - Country:US
Mailing Address - Phone:310-402-3395
Mailing Address - Fax:
Practice Address - Street 1:2020 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4600
Practice Address - Country:US
Practice Address - Phone:909-873-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist