Provider Demographics
NPI:1740078211
Name:GOBREYAL, ANGIE (RPH)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:GOBREYAL
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 VIA CERVANO
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-6657
Mailing Address - Country:US
Mailing Address - Phone:602-531-9166
Mailing Address - Fax:
Practice Address - Street 1:150 E LERDO HWY
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2702
Practice Address - Country:US
Practice Address - Phone:661-746-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist