Healthcare Provider Details

I. General information

NPI: 1154290120
Provider Name (Legal Business Name): BILAL QAISS KHDEER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 MEMORIAL DR
CHICOPEE MA
01020-3933
US

IV. Provider business mailing address

1616 MEMORIAL DR
CHICOPEE MA
01020-3933
US

V. Phone/Fax

Practice location:
  • Phone: 413-532-3299
  • Fax:
Mailing address:
  • Phone: 413-532-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1002654
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: