Healthcare Provider Details

I. General information

NPI: 1356218622
Provider Name (Legal Business Name): KHALID ELASED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 COLONEL GLENN HWY
DAYTON OH
45435-0002
US

IV. Provider business mailing address

10325 APPLE PARK CT
DAYTON OH
45458-9594
US

V. Phone/Fax

Practice location:
  • Phone: 937-775-2159
  • Fax: 937-775-7221
Mailing address:
  • Phone: 937-775-2159
  • Fax: 937-775-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03325452
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: