Provider Demographics
NPI:1003412867
Name:ALKAHTANI, NOUF KHALID
Entity Type:Individual
Prefix:
First Name:NOUF
Middle Name:KHALID
Last Name:ALKAHTANI
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 1:15121 S BUDLONG AVE APT F
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3532
Mailing Address - Country:US
Mailing Address - Phone:215-460-5215
Mailing Address - Fax:
Practice Address - Street 1:1462 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1733
Practice Address - Country:US
Practice Address - Phone:928-783-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist