Provider Demographics
NPI:1649642588
Name:KHOURY, KHALED (PHARMD)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:KHOURY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W ORANGE HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-6344
Mailing Address - Country:US
Mailing Address - Phone:951-283-1785
Mailing Address - Fax:
Practice Address - Street 1:11080 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3047
Practice Address - Country:US
Practice Address - Phone:951-602-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 41263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist