Provider Demographics
NPI:1598057598
Name:KHALIL, KEFAH AHMAD (RPH)
Entity Type:Individual
Prefix:
First Name:KEFAH
Middle Name:AHMAD
Last Name:KHALIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KEFAH
Other - Middle Name:AHMAD
Other - Last Name:THAHER-KHALIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7505 MEADOW STREAM CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7548
Mailing Address - Country:US
Mailing Address - Phone:502-384-6186
Mailing Address - Fax:
Practice Address - Street 1:2022 E SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-1665
Practice Address - Country:US
Practice Address - Phone:812-949-0641
Practice Address - Fax:812-949-1068
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021965A183500000X
KY013995183500000X
IL051.290666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist