Provider Demographics
NPI:1841067907
Name:BOCTOR, RAFIK RAMY RIAD RIZK (RPH)
Entity type:Individual
Prefix:
First Name:RAFIK RAMY RIAD RIZK
Middle Name:
Last Name:BOCTOR
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 1:3395 MICHELSON DR APT 1406
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-4445
Mailing Address - Country:US
Mailing Address - Phone:909-969-0406
Mailing Address - Fax:
Practice Address - Street 1:132 S ANITA DR STE 210
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3317
Practice Address - Country:US
Practice Address - Phone:877-778-0318
Practice Address - Fax:877-778-0399
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH83587183500000X
TX68003183500000X
MI5302415008183500000X
ARPD16437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist