Provider Demographics
NPI:1619147295
Name:KHALIL, WANAS ANISS HANA
Entity Type:Individual
Prefix:MR
First Name:WANAS
Middle Name:ANISS HANA
Last Name:KHALIL
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 1:807 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1036
Mailing Address - Country:US
Mailing Address - Phone:718-565-1005
Mailing Address - Fax:718-565-1004
Practice Address - Street 1:807 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1036
Practice Address - Country:US
Practice Address - Phone:718-565-1005
Practice Address - Fax:718-565-1004
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist