Healthcare Provider Details

I. General information

NPI: 1164975538
Provider Name (Legal Business Name): SHUKRI SALIBA PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16402 PARAMOUNT BLVD
PARAMOUNT CA
90723-5428
US

IV. Provider business mailing address

16402 PARAMOUNT BLVD
PARAMOUNT CA
90723-5428
US

V. Phone/Fax

Practice location:
  • Phone: 562-220-2630
  • Fax:
Mailing address:
  • Phone: 562-220-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH45530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: