Provider Demographics
NPI:1366027658
Name:EL, KHADEEJAH AAYEESHAH
Entity Type:Individual
Prefix:
First Name:KHADEEJAH
Middle Name:AAYEESHAH
Last Name:EL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3717
Mailing Address - Country:US
Mailing Address - Phone:757-480-3051
Mailing Address - Fax:
Practice Address - Street 1:7530 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3717
Practice Address - Country:US
Practice Address - Phone:757-480-3051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230028639183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician