MEDICARE: RAHAF KHZAM

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	81961	CA

General Provider Information

NPI Number	:	1104578632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHAF KHZAM

Provider Business Mailing Address
First Line	:	216 S MAIN ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 S MAIN ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4205
Country	:	US
Telephone Number	:	707-961-1342
Fax Number	:

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

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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Directions to “ RAHAF KHZAM ” Practice Location

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