Healthcare Provider Details

I. General information

NPI: 1124340674
Provider Name (Legal Business Name): JAVED I KHOKHAR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CHERRYWOOD DR
GOSHEN NY
10924-2508
US

IV. Provider business mailing address

34 CHERRYWOOD DR
GOSHEN NY
10924-2508
US

V. Phone/Fax

Practice location:
  • Phone: 845-469-9316
  • Fax:
Mailing address:
  • Phone: 845-469-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040535-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: