Provider Demographics
NPI:1790396190
Name:KHAITOVA, ANGELA (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KHAITOVA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 CHEVY CHASE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1520
Mailing Address - Country:US
Mailing Address - Phone:347-337-2300
Mailing Address - Fax:
Practice Address - Street 1:8310 CHEVY CHASE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1520
Practice Address - Country:US
Practice Address - Phone:347-337-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist