MEDICARE: NAHLA KHALAF

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	43596	CA

General Provider Information

NPI Number	:	1932554011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAHLA KHALAF

Provider Business Mailing Address
First Line	:	201 N LOS ANGELES ST STE 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-3318
Country	:	US
Telephone Number	:	213-620-1491
Fax Number	:	213-620-9036

Provider Business Practice Location Address
First Line	:	201 N LOS ANGELES ST STE 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-3318
Country	:	US
Telephone Number	:	213-620-1491
Fax Number	:	213-620-9036

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

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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