Provider Demographics
NPI:1104673748
Name:KHAMAR, MOHITA
Entity type:Individual
Prefix:
First Name:MOHITA
Middle Name:
Last Name:KHAMAR
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 1:612 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-4311
Mailing Address - Country:US
Mailing Address - Phone:908-822-3300
Mailing Address - Fax:
Practice Address - Street 1:1147 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-1934
Practice Address - Country:US
Practice Address - Phone:908-757-7703
Practice Address - Fax:908-757-2084
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04364000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist