Provider Demographics
NPI:1952569188
Name:KHATIB, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:KHATIB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 S VENOY RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4600
Mailing Address - Country:US
Mailing Address - Phone:734-728-1591
Mailing Address - Fax:734-729-6546
Practice Address - Street 1:1956 S VENOY RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4600
Practice Address - Country:US
Practice Address - Phone:734-728-1591
Practice Address - Fax:734-729-6546
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist