Healthcare Provider Details

I. General information

NPI: 1194807107
Provider Name (Legal Business Name): MARWA KHALIFA PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WEST KINGSBRIDGE ROAD
BRONX NY
10468
US

IV. Provider business mailing address

3711 28TH AVE APT 17
ASTORIA NY
11103-4207
US

V. Phone/Fax

Practice location:
  • Phone: 718-204-4836
  • Fax:
Mailing address:
  • Phone: 718-204-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: