MEDICARE: JESSICA EL KHOURY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS63699	FL

General Provider Information

NPI Number	:	1164149571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA EL KHOURY

Provider Business Mailing Address
First Line	:	27841 CROWN LAKE BLVD
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4200
Country	:	US
Telephone Number	:	239-992-2130
Fax Number	:	239-498-5702

Provider Business Practice Location Address
First Line	:	27841 CROWN LAKE BLVD
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4200
Country	:	US
Telephone Number	:	713-858-4391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	10/26/2022

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Directions to “ JESSICA EL KHOURY ” Practice Location

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