Provider Demographics
NPI:1013068295
Name:KHADER, RAWAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RAWAN
Middle Name:
Last Name:KHADER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 17 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6835
Mailing Address - Country:US
Mailing Address - Phone:586-268-6266
Mailing Address - Fax:
Practice Address - Street 1:3979 17 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6835
Practice Address - Country:US
Practice Address - Phone:586-268-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030046183500000X
OH03-2-19525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist