Healthcare Provider Details

I. General information

NPI: 1255511580
Provider Name (Legal Business Name): ALI KHEMILI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 11/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 BALLTOWN RD
SCHENECTADY NY
12304-2245
US

IV. Provider business mailing address

442 BALLTOWN RD
SCHENECTADY NY
12304-2245
US

V. Phone/Fax

Practice location:
  • Phone: 518-346-6218
  • Fax: 518-346-6384
Mailing address:
  • Phone: 518-346-6218
  • Fax: 518-346-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: