Provider Demographics
NPI:1386017739
Name:EL KHOURY, GHASSAN
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:
Last Name:EL KHOURY
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 1:10371 CAMINO RUIZ APT 84
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3292
Mailing Address - Country:US
Mailing Address - Phone:858-242-9889
Mailing Address - Fax:
Practice Address - Street 1:1302 W MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1413
Practice Address - Country:US
Practice Address - Phone:760-471-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist