Provider Demographics
NPI:1740723949
Name:GAIEB, KHALIL (PHARMD)
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:
Last Name:GAIEB
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 1:1330 W MCNEESE ST APT 5213
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4523
Mailing Address - Country:US
Mailing Address - Phone:562-912-0542
Mailing Address - Fax:
Practice Address - Street 1:1201 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3609
Practice Address - Country:US
Practice Address - Phone:619-477-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021837183500000X
CARPH80291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist