Provider Demographics
NPI:1619489614
Name:GUIRGUIS, EVETTE (RPH)
Entity Type:Individual
Prefix:
First Name:EVETTE
Middle Name:
Last Name:GUIRGUIS
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 1:591 COUNTRY CLUB DR STE C
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7691
Mailing Address - Country:US
Mailing Address - Phone:805-584-2053
Mailing Address - Fax:805-584-2447
Practice Address - Street 1:591 COUNTRY CLUB DR STE C
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7691
Practice Address - Country:US
Practice Address - Phone:805-584-2053
Practice Address - Fax:805-584-2447
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist