Provider Demographics
NPI:1407133739
Name:KHOURY, MOUNA (RPH)
Entity Type:Individual
Prefix:
First Name:MOUNA
Middle Name:
Last Name:KHOURY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30604 ROYAL WOODS PL
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3772
Mailing Address - Country:US
Mailing Address - Phone:440-250-2598
Mailing Address - Fax:
Practice Address - Street 1:9211 EUCLID AVE # JJ-10
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2043
Practice Address - Country:US
Practice Address - Phone:216-444-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist