Healthcare Provider Details

I. General information

NPI: 1427344902
Provider Name (Legal Business Name): KHURSHID ALAM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ASHBROOKE DR
VOORHEES NJ
08043-2816
US

IV. Provider business mailing address

1147 COOPER ST
EDGEWATER PARK NJ
08010-2558
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6688
  • Fax:
Mailing address:
  • Phone: 609-877-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02358700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: