Provider Demographics
NPI:1649626227
Name:KHALIL, SALLY (RPH)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:KHALIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30824 SAWGRASS LN
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6850
Mailing Address - Country:US
Mailing Address - Phone:440-840-4470
Mailing Address - Fax:
Practice Address - Street 1:30824 SAWGRASS LN
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6850
Practice Address - Country:US
Practice Address - Phone:440-840-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03134351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist