Provider Demographics
NPI:1972729036
Name:ATTAR, KHALED (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:KHALED
Middle Name:
Last Name:ATTAR
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 SHREWSBURY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-3683
Mailing Address - Country:US
Mailing Address - Phone:248-393-3344
Mailing Address - Fax:
Practice Address - Street 1:10 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8818
Practice Address - Country:US
Practice Address - Phone:248-627-2888
Practice Address - Fax:248-627-1218
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist