=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619620887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEBA CHAKOUKANI JUBRAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2022
-----------------------------------------------------
Last Update Date | 12/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13831 BROOKHURST ST
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-726-8332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 E KATELLA AVE APT 4055
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805-6668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-726-8332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH83750
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------