Provider Demographics
NPI:1558644229
Name:KHOURY, CANAAN DAVID II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CANAAN
Middle Name:DAVID
Last Name:KHOURY
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BEAR HILL RD
Mailing Address - Street 2:401
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1025
Mailing Address - Country:US
Mailing Address - Phone:781-890-2362
Mailing Address - Fax:
Practice Address - Street 1:972 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4701
Practice Address - Country:US
Practice Address - Phone:617-327-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist