Healthcare Provider Details

I. General information

NPI: 1801620646
Provider Name (Legal Business Name): AYSYLU KHALIULLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 02/16/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 33RD ST
BALTIMORE MD
21218-3505
US

IV. Provider business mailing address

601 E 33RD ST
BALTIMORE MD
21218-3505
US

V. Phone/Fax

Practice location:
  • Phone: 410-649-4180
  • Fax:
Mailing address:
  • Phone: 410-649-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29907
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number29907
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: