Provider Demographics
NPI:1972197861
Name:ABOUKHADIJEH, ROUA H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROUA
Middle Name:H
Last Name:ABOUKHADIJEH
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 1:13046 EMPTY SADDLE CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6306
Mailing Address - Country:US
Mailing Address - Phone:949-505-2484
Mailing Address - Fax:
Practice Address - Street 1:6215 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2179
Practice Address - Country:US
Practice Address - Phone:949-505-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist