Provider Demographics
NPI:1699046227
Name:KHAIMOV, AVNER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AVNER
Middle Name:
Last Name:KHAIMOV
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 1:1820 E 13TH ST
Mailing Address - Street 2:2R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 E 13TH ST
Practice Address - Street 2:2R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2850
Practice Address - Country:US
Practice Address - Phone:718-556-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist