Healthcare Provider Details

I. General information

NPI: 1518496306
Provider Name (Legal Business Name): SERENA KHALILY PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7021 HOLLYWOOD BLVD
LOS ANGELES CA
90028-6027
US

IV. Provider business mailing address

7021 HOLLYWOOD BLVD
LOS ANGELES CA
90028-6027
US

V. Phone/Fax

Practice location:
  • Phone: 323-836-0307
  • Fax: 323-836-0311
Mailing address:
  • Phone: 323-836-0307
  • Fax: 323-836-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: