Provider Demographics
NPI:1760601645
Name:SHROFF, RESHMA (RPH)
Entity Type:Individual
Prefix:
First Name:RESHMA
Middle Name:
Last Name:SHROFF
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 1:3452 ROSSMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:ROSSMOOR
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4347
Mailing Address - Country:US
Mailing Address - Phone:562-493-0175
Mailing Address - Fax:562-431-5863
Practice Address - Street 1:11172 LOS ALAMITOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3621
Practice Address - Country:US
Practice Address - Phone:562-430-3323
Practice Address - Fax:562-431-5863
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45223OtherPHARMACIST LICENSE #