Provider Demographics
NPI:1215161682
Name:SHENOUDA, IRMA WASSIF (PHARMD)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:WASSIF
Last Name:SHENOUDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17296 SLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7585
Mailing Address - Country:US
Mailing Address - Phone:909-609-3360
Mailing Address - Fax:909-609-3398
Practice Address - Street 1:17296 SLOVER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7585
Practice Address - Country:US
Practice Address - Phone:909-609-3360
Practice Address - Fax:909-609-3398
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist