Provider Demographics
NPI:1497216808
Name:KHIZGILOVA, ROSE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:KHIZGILOVA
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 1:260 OCEAN PKWY APT 4F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4050
Mailing Address - Country:US
Mailing Address - Phone:718-287-1040
Mailing Address - Fax:
Practice Address - Street 1:260 OCEAN PKWY APT 4F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4050
Practice Address - Country:US
Practice Address - Phone:718-287-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist