Provider Demographics
NPI:1295344364
Name:KHALAF, MAIE GAMAL FATHALLA (RPH)
Entity type:Individual
Prefix:
First Name:MAIE
Middle Name:GAMAL FATHALLA
Last Name:KHALAF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40125 LOS ALAMOS RD APT F157
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5843
Mailing Address - Country:US
Mailing Address - Phone:951-404-8388
Mailing Address - Fax:
Practice Address - Street 1:760 WASHBURN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3303
Practice Address - Country:US
Practice Address - Phone:951-707-4500
Practice Address - Fax:951-707-4499
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist