Provider Demographics
NPI:1427319805
Name:KHANAKAH, JUAN A (RPH)
Entity type:Individual
Prefix:MS
First Name:JUAN
Middle Name:A
Last Name:KHANAKAH
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 1:25399 THE OLD RD APT 12207
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1626
Mailing Address - Country:US
Mailing Address - Phone:925-457-9547
Mailing Address - Fax:
Practice Address - Street 1:618 MICHILLINDA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6342
Practice Address - Country:US
Practice Address - Phone:626-821-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist