Provider Demographics
NPI:1912276627
Name:KHOKHLOV, OLGA S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:S
Last Name:KHOKHLOV
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 1:14618 VICTORY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1656
Mailing Address - Country:US
Mailing Address - Phone:818-376-8316
Mailing Address - Fax:
Practice Address - Street 1:14618 VICTORY BLVD STE B
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1656
Practice Address - Country:US
Practice Address - Phone:818-376-8316
Practice Address - Fax:818-376-1581
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH62951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANONEOtherNONE