Provider Demographics
NPI:1972196939
Name:KHUBANI, MYTHILI (PHARMD)
Entity Type:Individual
Prefix:
First Name:MYTHILI
Middle Name:
Last Name:KHUBANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MILI
Other - Middle Name:
Other - Last Name:KHUBANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:350 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-1746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-1746
Practice Address - Country:US
Practice Address - Phone:973-939-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03375100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist