Provider Demographics
NPI:1144771064
Name:HALIM, GHANDI
Entity Type:Individual
Prefix:
First Name:GHANDI
Middle Name:
Last Name:HALIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4521
Mailing Address - Country:US
Mailing Address - Phone:562-616-0056
Mailing Address - Fax:
Practice Address - Street 1:3717 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4521
Practice Address - Country:US
Practice Address - Phone:562-616-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist