Healthcare Provider Details

I. General information

NPI: 1184392144
Provider Name (Legal Business Name): KHAMATTIE UZAGIR PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 BEACH 116TH ST
ROCKAWAY PARK NY
11694-2417
US

IV. Provider business mailing address

8710 149TH AVE APT 5F
HOWARD BEACH NY
11414-1432
US

V. Phone/Fax

Practice location:
  • Phone: 718-318-0300
  • Fax:
Mailing address:
  • Phone: 347-698-7743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068126
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: