Provider Demographics
NPI:1881979060
Name:SEDKI, KHALED (RPH, MBA)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:SEDKI
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7382 COLCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3187
Mailing Address - Country:US
Mailing Address - Phone:248-349-6761
Mailing Address - Fax:
Practice Address - Street 1:1619 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-4609
Practice Address - Country:US
Practice Address - Phone:530-674-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist