Healthcare Provider Details

I. General information

NPI: 1801579081
Provider Name (Legal Business Name): MOHAMMED KHEDR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 MONTAGUE AVE
ISELIN NJ
08830-2500
US

IV. Provider business mailing address

908 MONTAGUE AVE
ISELIN NJ
08830-2500
US

V. Phone/Fax

Practice location:
  • Phone: 908-342-4232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03626500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: