Provider Demographics
NPI:1578332771
Name:KHANAFER, AYMAN MOHSEN
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:MOHSEN
Last Name:KHANAFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 POTTSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8480
Mailing Address - Country:US
Mailing Address - Phone:313-409-4488
Mailing Address - Fax:
Practice Address - Street 1:212 POTTSVILLE ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-8480
Practice Address - Country:US
Practice Address - Phone:570-385-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist