Provider Demographics
NPI:1003364159
Name:KHALATBARY, TORAJ (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TORAJ
Middle Name:
Last Name:KHALATBARY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231025
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02123-1025
Mailing Address - Country:US
Mailing Address - Phone:617-699-9079
Mailing Address - Fax:
Practice Address - Street 1:87 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1121
Practice Address - Country:US
Practice Address - Phone:617-699-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH 25334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist