Provider Demographics
NPI:1497346365
Name:KHATRI, SAMINA (RPH)
Entity Type:Individual
Prefix:
First Name:SAMINA
Middle Name:
Last Name:KHATRI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 WHITESTONE CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3116
Mailing Address - Country:US
Mailing Address - Phone:404-988-0220
Mailing Address - Fax:
Practice Address - Street 1:4025 LAWRENCEVILLE HWY NW STE D
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2876
Practice Address - Country:US
Practice Address - Phone:770-710-0478
Practice Address - Fax:770-710-0861
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA025557OtherGEORGIA BOARD OF PHARMACY LICENSE