Provider Demographics
NPI:1700425204
Name:KHALED, MENA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MENA
Middle Name:
Last Name:KHALED
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 1:9031 BIG CHIEF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6605
Mailing Address - Country:US
Mailing Address - Phone:314-326-6552
Mailing Address - Fax:
Practice Address - Street 1:9031 BIG CHIEF DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6605
Practice Address - Country:US
Practice Address - Phone:314-326-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019029051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist