Provider Demographics
NPI:1386345999
Name:GHANDOUR, KHALED (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KHALED
Middle Name:
Last Name:GHANDOUR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 BAYBERRY POINTE DR NW APT G
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-4633
Mailing Address - Country:US
Mailing Address - Phone:248-910-5710
Mailing Address - Fax:
Practice Address - Street 1:5300 HARVEY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-6716
Practice Address - Country:US
Practice Address - Phone:231-799-6910
Practice Address - Fax:231-799-6965
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302046244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist