Provider Demographics
NPI:1184325219
Name:KHAJA, FATIMA A (PHARMD, PHD)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:A
Last Name:KHAJA
Suffix:
Gender:F
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 WAHOO RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7266
Mailing Address - Country:US
Mailing Address - Phone:847-338-7975
Mailing Address - Fax:
Practice Address - Street 1:3104 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1829
Practice Address - Country:US
Practice Address - Phone:850-215-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2947381835P2201X
FLPS62508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care