Provider Demographics
NPI:1831752484
Name:KHOURY, HEATHER CHRISTINE (PHARMD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:KHOURY
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 1:3141 PELLARO CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-2104
Mailing Address - Country:US
Mailing Address - Phone:925-699-7163
Mailing Address - Fax:
Practice Address - Street 1:2810 S TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8127
Practice Address - Country:US
Practice Address - Phone:209-843-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist