Provider Demographics
NPI:1720825110
Name:HENIGAL, RADWA A
Entity type:Individual
Prefix:
First Name:RADWA
Middle Name:A
Last Name:HENIGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 N CITRUS AVE APT 37
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-1734
Mailing Address - Country:US
Mailing Address - Phone:714-363-6879
Mailing Address - Fax:
Practice Address - Street 1:1430 N CITRUS AVE APT 37
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-1734
Practice Address - Country:US
Practice Address - Phone:714-363-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH89482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist