Provider Demographics
NPI:1407677172
Name:KHADIJAH KREATIONS
Entity type:Organization
Organization Name:KHADIJAH KREATIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DME PROVIDER
Authorized Official - Phone:484-649-6575
Mailing Address - Street 1:351 W SCHUYLKILL RD STE B2
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-9639
Mailing Address - Country:US
Mailing Address - Phone:267-241-2213
Mailing Address - Fax:
Practice Address - Street 1:351 W SCHUYLKILL RD STE B2
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-9639
Practice Address - Country:US
Practice Address - Phone:267-241-2213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies