Provider Demographics
NPI:1740502939
Name:HABIB, KHALID (RPH)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:HABIB
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 1:103 WESTCOMBE PARK
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9465
Mailing Address - Country:US
Mailing Address - Phone:585-334-3821
Mailing Address - Fax:
Practice Address - Street 1:1200 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-6002
Practice Address - Country:US
Practice Address - Phone:585-292-0990
Practice Address - Fax:585-292-0997
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist