Provider Demographics
NPI:1720106727
Name:MAHFOUZ, KHALID H (RPH)
Entity Type:Individual
Prefix:MR
First Name:KHALID
Middle Name:H
Last Name:MAHFOUZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34875 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6841
Mailing Address - Country:US
Mailing Address - Phone:909-797-7329
Mailing Address - Fax:
Practice Address - Street 1:34875 MAPLEWOOD LN
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-6841
Practice Address - Country:US
Practice Address - Phone:909-797-7329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 47882OtherCALIFORNIA PHARMACIST