Healthcare Provider Details

I. General information

NPI: 1780963728
Provider Name (Legal Business Name): AALIYAH KHATIB PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 PIEDMONT RD NE
ATLANTA GA
30305-7044
US

IV. Provider business mailing address

3495 PEIDMONT ROAD NE
ATLANTA GA
30305-7044
US

V. Phone/Fax

Practice location:
  • Phone: 404-663-3387
  • Fax:
Mailing address:
  • Phone: 404-663-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH024804
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: