Provider Demographics
NPI:1740997568
Name:KHALID, HUMAIRA
Entity type:Individual
Prefix:MRS
First Name:HUMAIRA
Middle Name:
Last Name:KHALID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 TRIBOU ST UNIT 24
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6482
Mailing Address - Country:US
Mailing Address - Phone:732-318-5426
Mailing Address - Fax:
Practice Address - Street 1:83 TRIBOU ST UNIT 24
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6482
Practice Address - Country:US
Practice Address - Phone:732-318-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty