Provider Demographics
NPI:1821610619
Name:KHAJURIA, KIRIT
Entity Type:Individual
Prefix:
First Name:KIRIT
Middle Name:
Last Name:KHAJURIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8208 SWAMP ROSE PL
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1963
Mailing Address - Country:US
Mailing Address - Phone:240-475-4998
Mailing Address - Fax:
Practice Address - Street 1:15618 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1630
Practice Address - Country:US
Practice Address - Phone:301-421-4493
Practice Address - Fax:301-421-1123
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10688OtherPHARMACIST LICENSE NO.