Provider Demographics
NPI:1861712499
Name:KHATIB, MOHAMED A (RPH)
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:A
Last Name:KHATIB
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 1:158 SAND HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-3103
Mailing Address - Country:US
Mailing Address - Phone:551-206-9251
Mailing Address - Fax:
Practice Address - Street 1:158 SAND HILLS RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-3103
Practice Address - Country:US
Practice Address - Phone:551-206-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03058500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist