Provider Demographics
NPI:1629353081
Name:AKHTAR, HALLAH IRIM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HALLAH
Middle Name:IRIM
Last Name:AKHTAR
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 1:6043 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8097
Mailing Address - Country:US
Mailing Address - Phone:336-310-3931
Mailing Address - Fax:
Practice Address - Street 1:340 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2881
Practice Address - Country:US
Practice Address - Phone:336-993-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist