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General NPI Number Information
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NPI Number | 1548874381
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Entity Type | Individual
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Provider Name | MAHMOUD KHALIL
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Gender | Male
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 15 W HARDING WAY
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City | STOCKTON
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State | CA
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Zip | 95204-5716
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Country | US
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Telephone | 209-941-9632
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8081
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City | STOCKTON
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State | CA
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Zip | 95208-0081
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Country | US
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Telephone | 915-255-6393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 78513
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License Number State | CA
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