Provider Demographics
NPI:1124850276
Name:ALKHABAZ, JACK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:ALKHABAZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2410
Mailing Address - Country:US
Mailing Address - Phone:718-435-8800
Mailing Address - Fax:718-435-7624
Practice Address - Street 1:4514 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2410
Practice Address - Country:US
Practice Address - Phone:718-435-8800
Practice Address - Fax:718-435-7624
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist