Provider Demographics
NPI:1407170749
Name:CHAK, KHALID S (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:S
Last Name:CHAK
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3112
Mailing Address - Country:US
Mailing Address - Phone:845-358-0205
Mailing Address - Fax:845-358-5240
Practice Address - Street 1:114 MAIN ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3112
Practice Address - Country:US
Practice Address - Phone:845-358-0205
Practice Address - Fax:845-358-5240
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist