Provider Demographics
NPI:1982163630
Name:SHEHATA, RAFAL (RPH)
Entity Type:Individual
Prefix:
First Name:RAFAL
Middle Name:
Last Name:SHEHATA
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 1:7822 NE 24TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-1137
Mailing Address - Country:US
Mailing Address - Phone:360-433-8784
Mailing Address - Fax:
Practice Address - Street 1:144 SW 20TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1804
Practice Address - Country:US
Practice Address - Phone:541-278-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASHEHARK099Q5OtherWASHINGTON DRIVER LICENSE