Provider Demographics
NPI:1629844352
Name:KHALIL, MINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:KHALIL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 KENNEDY BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5235
Mailing Address - Country:US
Mailing Address - Phone:717-758-0513
Mailing Address - Fax:
Practice Address - Street 1:29 VER VALEN ST
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2699
Practice Address - Country:US
Practice Address - Phone:201-367-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04252700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist