Provider Demographics
NPI:1336981059
Name:SHAFIK, DIANA DANIAL ABDOU (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:DANIAL ABDOU
Last Name:SHAFIK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21014 E CIENEGA AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1413
Mailing Address - Country:US
Mailing Address - Phone:909-516-1790
Mailing Address - Fax:
Practice Address - Street 1:8283 GROVE AVE STE 108
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3139
Practice Address - Country:US
Practice Address - Phone:909-480-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist