Provider Demographics
NPI:1689267601
Name:KHALIL, NAGY SALEH
Entity Type:Individual
Prefix:
First Name:NAGY
Middle Name:SALEH
Last Name:KHALIL
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 1:1504 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6601
Mailing Address - Country:US
Mailing Address - Phone:864-888-4022
Mailing Address - Fax:
Practice Address - Street 1:1504 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6601
Practice Address - Country:US
Practice Address - Phone:864-888-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist