Provider Demographics
NPI:1699187112
Name:ABDELKARIM, KHALED
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:ABDELKARIM
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 1:1076 KERN ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-2743
Mailing Address - Country:US
Mailing Address - Phone:661-763-3132
Mailing Address - Fax:
Practice Address - Street 1:1076 KERN ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2743
Practice Address - Country:US
Practice Address - Phone:661-763-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist