Provider Demographics
NPI:1043761752
Name:KHALOU, DEBORAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KHALOU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BRAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1325
Mailing Address - Country:US
Mailing Address - Phone:516-498-7547
Mailing Address - Fax:
Practice Address - Street 1:34 BRAMPTON LN
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1325
Practice Address - Country:US
Practice Address - Phone:516-498-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist