MEDICARE: DEBORAH KHALOU PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	062115	NY

General Provider Information

NPI Number	:	1043761752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH KHALOU PHARM.D.

Provider Business Mailing Address
First Line	:	34 BRAMPTON LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1325
Country	:	US
Telephone Number	:	516-498-7547
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 BRAMPTON LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1325
Country	:	US
Telephone Number	:	516-498-7547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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