Provider Demographics
NPI:1629873757
Name:KHAMBUM, NAVEEN (RPH)
Entity type:Individual
Prefix:
First Name:NAVEEN
Middle Name:
Last Name:KHAMBUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10055 WINDSTREAM DR APT 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2535
Mailing Address - Country:US
Mailing Address - Phone:443-935-6285
Mailing Address - Fax:
Practice Address - Street 1:2300 GARRISON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2309
Practice Address - Country:US
Practice Address - Phone:410-233-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist