Provider Demographics
NPI:1407448038
Name:SHIFMAN, GAIL RENEE (RPH)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:RENEE
Last Name:SHIFMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5685 BALBOA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5685 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2705
Practice Address - Country:US
Practice Address - Phone:858-279-2860
Practice Address - Fax:858-279-0424
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2024-09-09
Deactivation Date:2024-01-25
Deactivation Code:
Reactivation Date:2024-06-24
Provider Licenses
StateLicense IDTaxonomies
CA53820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist