Provider Demographics
NPI:1578748984
Name:KHUU, JOE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:KHUU
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 1:8312 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4403
Mailing Address - Country:US
Mailing Address - Phone:718-748-2177
Mailing Address - Fax:718-748-2188
Practice Address - Street 1:8312 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4403
Practice Address - Country:US
Practice Address - Phone:718-748-2177
Practice Address - Fax:718-748-2188
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02843832Medicaid
NY5834510001Medicare NSC