Provider Demographics
NPI:1407170160
Name:KHAYUMOVA, MARGARITA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:KHAYUMOVA
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 1:7530 190TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1856
Mailing Address - Country:US
Mailing Address - Phone:917-617-8663
Mailing Address - Fax:718-740-2562
Practice Address - Street 1:10525 64TH AVE APT 4E
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1673
Practice Address - Country:US
Practice Address - Phone:917-617-8663
Practice Address - Fax:718-268-4099
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist