Provider Demographics
NPI:1386992519
Name:KHALIL, SAMEH FAWZY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:FAWZY
Last Name:KHALIL
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 1:253 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2926
Mailing Address - Country:US
Mailing Address - Phone:212-254-1454
Mailing Address - Fax:
Practice Address - Street 1:253 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2926
Practice Address - Country:US
Practice Address - Phone:212-254-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist