Healthcare Provider Details

I. General information

NPI: 1912821109
Provider Name (Legal Business Name): ISTAFRO MICHAEL KHALIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 JFK BLVD APT 2
ENDWELL NY
13760-1836
US

IV. Provider business mailing address

1023 JFK BLVD APT 2
ENDWELL NY
13760-1836
US

V. Phone/Fax

Practice location:
  • Phone: 347-553-1426
  • Fax:
Mailing address:
  • Phone: 347-553-1426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074255
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: