Provider Demographics
NPI:1619523834
Name:MIKHAIL, MANAL
Entity Type:Individual
Prefix:
First Name:MANAL
Middle Name:
Last Name:MIKHAIL
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 1:1010 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1020
Mailing Address - Country:US
Mailing Address - Phone:626-209-8169
Mailing Address - Fax:626-209-8171
Practice Address - Street 1:1010 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1020
Practice Address - Country:US
Practice Address - Phone:626-209-8169
Practice Address - Fax:626-209-8171
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist