Provider Demographics
NPI:1073132676
Name:RHODES, KHUSHBOO S (PHARMD)
Entity Type:Individual
Prefix:
First Name:KHUSHBOO
Middle Name:S
Last Name:RHODES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KHUSHBO
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3101 ROSWELL RD STE 132
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5523
Mailing Address - Country:US
Mailing Address - Phone:678-695-4961
Mailing Address - Fax:
Practice Address - Street 1:3101 ROSWELL RD STE 132
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5523
Practice Address - Country:US
Practice Address - Phone:678-695-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL169601835P0018X
FLPS529171835P0018X
GARPH0265501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist