Provider Demographics
NPI:1801505912
Name:KHAIRALLA, AHMAD (PHARMACIST)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:KHAIRALLA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CEDAR ST STE 404
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3500
Mailing Address - Country:US
Mailing Address - Phone:347-279-5714
Mailing Address - Fax:
Practice Address - Street 1:425 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-3683
Practice Address - Country:US
Practice Address - Phone:978-373-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist