Provider Demographics
NPI:1760992226
Name:RAKHOLIA, SAMEER K (RPH)
Entity Type:Individual
Prefix:
First Name:SAMEER
Middle Name:K
Last Name:RAKHOLIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S PERALTA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3644
Mailing Address - Country:US
Mailing Address - Phone:714-299-1982
Mailing Address - Fax:
Practice Address - Street 1:1717 E VISTA CHINO STE B2
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-3569
Practice Address - Country:US
Practice Address - Phone:760-322-6700
Practice Address - Fax:760-322-2266
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH64946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH64946OtherPHARMACIST LICENSE