Provider Demographics
NPI:1992441505
Name:HALIM, MINA MAGDY MEGALLY
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:MAGDY MEGALLY
Last Name:HALIM
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 1:83316 BEAVER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-2830
Mailing Address - Country:US
Mailing Address - Phone:614-316-0887
Mailing Address - Fax:
Practice Address - Street 1:82270 US HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5651
Practice Address - Country:US
Practice Address - Phone:760-342-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist