Provider Demographics
NPI:1336829548
Name:GABALLAH, NANCY (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GABALLAH
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 1:15853 MONTE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-7671
Mailing Address - Country:US
Mailing Address - Phone:818-696-0606
Mailing Address - Fax:
Practice Address - Street 1:15853 MONTE ST STE 101
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-7671
Practice Address - Country:US
Practice Address - Phone:818-696-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist