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General NPI Number Information
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NPI Number | 1164708657
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Entity Type | Individual
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Provider Name | DR. RAGY S GERGIS
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Gender | Male
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 120 W PARKRIDGE AVE
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City | CORONA
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State | CA
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Zip | 92880-1450
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Country | US
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Telephone | 951-278-1852
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Fax |
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Provider Business Mailing Address
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Address Line | 664 AVONDALE DR
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City | CORONA
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State | CA
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Zip | 92879-8556
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Country | US
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Telephone | 909-395-7528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | 59000
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 59000
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 59000
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 59000
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License Number State | CA
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