Provider Demographics
NPI:1982210209
Name:KHALEL, CLARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:KHALEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-2011
Mailing Address - Country:US
Mailing Address - Phone:551-666-1373
Mailing Address - Fax:
Practice Address - Street 1:699 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4724
Practice Address - Country:US
Practice Address - Phone:201-243-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04124900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist