Provider Demographics
NPI:1649272428
Name:KHALIL, ODETTE PASHA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ODETTE
Middle Name:PASHA
Last Name:KHALIL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 CALLE SIMPATICO
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-3031
Mailing Address - Country:US
Mailing Address - Phone:818-241-3667
Mailing Address - Fax:818-500-8049
Practice Address - Street 1:9209 COLIMA RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1863
Practice Address - Country:US
Practice Address - Phone:562-789-5852
Practice Address - Fax:562-789-5854
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH48170OtherPHARMACIST LICENSE