Provider Demographics
NPI:1013787464
Name:KHALIFA, YOUSSEF
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:
Last Name:KHALIFA
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 1:10720 BRIMHALL RD APT 123
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3095
Mailing Address - Country:US
Mailing Address - Phone:909-745-3739
Mailing Address - Fax:
Practice Address - Street 1:2323 16TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3420
Practice Address - Country:US
Practice Address - Phone:661-324-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist