Provider Demographics
NPI:1427361039
Name:KHAJA, NAZEER UDDIN (RPH)
Entity Type:Individual
Prefix:
First Name:NAZEER
Middle Name:UDDIN
Last Name:KHAJA
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 1:16 PECK FARM RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1565
Mailing Address - Country:US
Mailing Address - Phone:207-377-2279
Mailing Address - Fax:207-377-7768
Practice Address - Street 1:16 PECK FARM RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1565
Practice Address - Country:US
Practice Address - Phone:207-377-2279
Practice Address - Fax:207-377-7768
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist