Provider Demographics
NPI:1336687334
Name:KHALIL, MICHAEL R (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:KHALIL
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 1:2129 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4411
Mailing Address - Country:US
Mailing Address - Phone:727-488-1190
Mailing Address - Fax:
Practice Address - Street 1:2129 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4411
Practice Address - Country:US
Practice Address - Phone:202-299-0138
Practice Address - Fax:202-299-1094
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100002460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist