Provider Demographics
NPI:1164111738
Name:YOUKHANA, MARY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:YOUKHANA
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 1:8214 E COUNTY DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-8827
Mailing Address - Country:US
Mailing Address - Phone:209-277-0889
Mailing Address - Fax:
Practice Address - Street 1:602 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-2207
Practice Address - Country:US
Practice Address - Phone:619-321-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist