Provider Demographics
NPI:1790366599
Name:CHAUDHRY, KHALID MAHMOOD (1835000000X)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:MAHMOOD
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:1835000000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 S ITHAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1226
Mailing Address - Country:US
Mailing Address - Phone:610-525-7233
Mailing Address - Fax:
Practice Address - Street 1:461 S ITHAN AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1226
Practice Address - Country:US
Practice Address - Phone:610-525-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028398L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist