Provider Demographics
NPI:1538329800
Name:CHAUDHARY, KHALID MAHMOOD (RPH)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:MAHMOOD
Last Name:CHAUDHARY
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 1:100 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1616
Mailing Address - Country:US
Mailing Address - Phone:631-477-1111
Mailing Address - Fax:631-477-1218
Practice Address - Street 1:100 FRONT ST
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1616
Practice Address - Country:US
Practice Address - Phone:631-477-1111
Practice Address - Fax:631-477-1218
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist