Healthcare Provider Details

I. General information

NPI: 1023400330
Provider Name (Legal Business Name): CHRISTOPHER KHEMRAJ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 W MERRICK RD
VALLEY STREAM NY
11580-5360
US

IV. Provider business mailing address

290 W MERRICK RD
VALLEY STREAM NY
11580-5360
US

V. Phone/Fax

Practice location:
  • Phone: 516-612-9121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058094
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: