Provider Demographics
NPI:1346955861
Name:ABU-KHAZNEH, SARA KHALED
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KHALED
Last Name:ABU-KHAZNEH
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 1:5505 ZELZAH AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2258
Mailing Address - Country:US
Mailing Address - Phone:661-348-2969
Mailing Address - Fax:
Practice Address - Street 1:18430 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4305
Practice Address - Country:US
Practice Address - Phone:818-343-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist