Provider Demographics
NPI:1255000378
Name:KHALIL, SAMEH (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMEH
Middle Name:
Last Name:KHALIL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 N MARIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2242
Mailing Address - Country:US
Mailing Address - Phone:248-403-3036
Mailing Address - Fax:
Practice Address - Street 1:822 N MARIA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2242
Practice Address - Country:US
Practice Address - Phone:248-403-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist