1548413776 NPI number — MRS. MAHA KHATIB CPHT

Table of content: MRS. MAHA KHATIB CPHT (NPI 1548413776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548413776 NPI number — MRS. MAHA KHATIB CPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHATIB
Provider First Name:
MAHA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548413776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6506 COUNTRYSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72116-3715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-753-3462
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 FORT ROOTS DR
Provider Second Line Business Practice Location Address:
PHARMACY SERVICE 119 BLDG. 66
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72114-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-257-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)