Provider Demographics
NPI:1134777139
Name:BACHOUA, SHAWKI MARROGI
Entity type:Individual
Prefix:
First Name:SHAWKI
Middle Name:MARROGI
Last Name:BACHOUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9836 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1901
Mailing Address - Country:US
Mailing Address - Phone:619-777-1000
Mailing Address - Fax:619-334-0049
Practice Address - Street 1:79 E EMERSON ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3547
Practice Address - Country:US
Practice Address - Phone:619-920-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH26490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist