Provider Demographics
NPI:1649755083
Name:SHAHBOL, MICHELLE LEAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEAH
Last Name:SHAHBOL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18215 SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3415
Mailing Address - Country:US
Mailing Address - Phone:818-416-8778
Mailing Address - Fax:
Practice Address - Street 1:3875 W RANCHO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-2572
Practice Address - Country:US
Practice Address - Phone:661-202-3604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist