MEDICARE: MR. MOHAMED A KHATIB RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI03058500	NJ

General Provider Information

NPI Number	:	1861712499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOHAMED A KHATIB RPH.

Provider Business Mailing Address
First Line	:	158 SAND HILLS RD
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-3103
Country	:	US
Telephone Number	:	551-206-9251
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 SAND HILLS RD
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-3103
Country	:	US
Telephone Number	:	551-206-9251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2010
Last Update Date	:	06/05/2010

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