Provider Demographics
NPI:1205151933
Name:BOUZIRI, KHALID (RPH)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:BOUZIRI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5309
Mailing Address - Country:US
Mailing Address - Phone:718-643-9505
Mailing Address - Fax:
Practice Address - Street 1:559 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5309
Practice Address - Country:US
Practice Address - Phone:718-643-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05343651174400000X
NY054365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No183500000XPharmacy Service ProvidersPharmacist