Provider Demographics
NPI:1467950006
Name:HAKIM, MIREILLE
Entity Type:Individual
Prefix:
First Name:MIREILLE
Middle Name:
Last Name:HAKIM
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 1:35751 GATEWAY DR UNIT L1230
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6047
Mailing Address - Country:US
Mailing Address - Phone:626-787-6946
Mailing Address - Fax:
Practice Address - Street 1:36919 COOK ST STE 102
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6069
Practice Address - Country:US
Practice Address - Phone:760-340-3248
Practice Address - Fax:760-340-3258
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist