Provider Demographics
NPI:1720313406
Name:FAKOOR, KHALED (PHARMD/RPH)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:
Last Name:FAKOOR
Suffix:
Gender:M
Credentials:PHARMD/RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 LAKEWOOD CENTER MALL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2409
Mailing Address - Country:US
Mailing Address - Phone:562-295-1515
Mailing Address - Fax:562-295-1512
Practice Address - Street 1:340 LAKEWOOD CENTER MALL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2409
Practice Address - Country:US
Practice Address - Phone:562-295-1515
Practice Address - Fax:562-295-1512
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist