Provider Demographics
NPI:1407452519
Name:KHALIL, MARIAM (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:KHALIL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 DEN RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-4537
Mailing Address - Country:US
Mailing Address - Phone:952-941-6728
Mailing Address - Fax:
Practice Address - Street 1:8015 DEN RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-4537
Practice Address - Country:US
Practice Address - Phone:952-941-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist