Provider Demographics
NPI:1134559172
Name:MERCURY HEALTH, INC
Entity type:Organization
Organization Name:MERCURY HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:TAWFIK IBRAHIM
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:619-565-9707
Mailing Address - Street 1:1420 E PLAZA BLVD
Mailing Address - Street 2:STE B-3
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3636
Mailing Address - Country:US
Mailing Address - Phone:619-565-9707
Mailing Address - Fax:
Practice Address - Street 1:1420 E PLAZA BLVD
Practice Address - Street 2:STE B-3
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3636
Practice Address - Country:US
Practice Address - Phone:619-565-9707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy