Provider Demographics
NPI:1306279971
Name:ELKHAYAT, OSAMA MOHAMED (PHARMACIST)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:MOHAMED
Last Name:ELKHAYAT
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 1:507 GRAND AVE # 2
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-1604
Mailing Address - Country:US
Mailing Address - Phone:201-222-3816
Mailing Address - Fax:718-274-6942
Practice Address - Street 1:507 GRAND AVE # 2
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-1604
Practice Address - Country:US
Practice Address - Phone:201-222-3816
Practice Address - Fax:718-274-6942
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist