MEDICARE: KHALED SALEM PHARMACIST

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	RP454747	PA

General Provider Information

NPI Number	:	1518611367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALED SALEM PHARMACIST

Provider Business Mailing Address
First Line	:	130 FAIRFIELD LN
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-3106
Country	:	US
Telephone Number	:	267-393-2240
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 E WYOMING AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-4532
Country	:	US
Telephone Number	:	215-621-6315
Fax Number	:

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

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	02/10/2022

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Directions to “ KHALED SALEM PHARMACIST” Practice Location

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