Provider Demographics
NPI:1700368339
Name:KHATIBI, NICOLE N (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:N
Last Name:KHATIBI
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 NEW AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9592
Mailing Address - Country:US
Mailing Address - Phone:469-515-4224
Mailing Address - Fax:
Practice Address - Street 1:5014 JEWEL ST UNIT 1415
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3263
Practice Address - Country:US
Practice Address - Phone:469-515-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60663183500000X
CA76899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist