Provider Demographics
NPI:1750600912
Name:KHALIL, MARCELLE S (RPH)
Entity type:Individual
Prefix:MS
First Name:MARCELLE
Middle Name:S
Last Name:KHALIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3953 CARMEL BROOKS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2250
Mailing Address - Country:US
Mailing Address - Phone:619-442-6013
Mailing Address - Fax:619-447-6033
Practice Address - Street 1:1135 AVOCADO BLVD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020
Practice Address - Country:US
Practice Address - Phone:619-442-6013
Practice Address - Fax:619-447-6033
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383471835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist