Healthcare Provider Details

I. General information

NPI: 1780501601
Provider Name (Legal Business Name): SANDY SHOKRALLA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N JACKSON ST APT 310
GLENDALE CA
91206-5139
US

IV. Provider business mailing address

515 N JACKSON ST APT 310
GLENDALE CA
91206-5139
US

V. Phone/Fax

Practice location:
  • Phone: 951-546-6053
  • Fax:
Mailing address:
  • Phone: 951-546-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: