Provider Demographics
NPI:1740828599
Name:ROUZITALAB, LILA (RPH)
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:
Last Name:ROUZITALAB
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 1:16800 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4909
Mailing Address - Country:US
Mailing Address - Phone:951-674-6836
Mailing Address - Fax:951-674-9773
Practice Address - Street 1:16800 LAKESHORE DR STE 1
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4909
Practice Address - Country:US
Practice Address - Phone:951-674-6836
Practice Address - Fax:951-674-9773
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist