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General NPI Number Information
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NPI Number | 1912392218
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Entity Type | Individual
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Provider Name | IVONA PROKOLAB
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Gender | Female
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 49908 JEFFERSON ST
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City | INDIO
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State | CA
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Zip | 92201-9720
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Country | US
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Telephone | 760-771-4524
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Fax |
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Provider Business Mailing Address
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Address Line | 79420 PASEO DEL REY
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City | LA QUINTA
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State | CA
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Zip | 92253-7218
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Country | US
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Telephone | 760-534-0289
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 62664
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License Number State | CA
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