Provider Demographics
NPI:1871921536
Name:ALKHOURY, KENAN
Entity type:Individual
Prefix:DR
First Name:KENAN
Middle Name:
Last Name:ALKHOURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 MOORE BLVD
Mailing Address - Street 2:APPT 230
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1818 MOORE BLVD
Practice Address - Street 2:APPT 230
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-7683
Practice Address - Country:US
Practice Address - Phone:858-248-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist