Provider Demographics
NPI:1487984043
Name:KHADIJA MAHEEN PHARMACY INC
Entity type:Organization
Organization Name:KHADIJA MAHEEN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PIC
Authorized Official - Prefix:
Authorized Official - First Name:HUMAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULEHRI
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:973-247-0786
Mailing Address - Street 1:7 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1014
Mailing Address - Country:US
Mailing Address - Phone:973-247-0786
Mailing Address - Fax:973-247-1786
Practice Address - Street 1:7 W BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1014
Practice Address - Country:US
Practice Address - Phone:973-247-0786
Practice Address - Fax:973-247-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336M0002X, 3336S0011X
NJ28RS00700800333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0245810Medicaid
NJ0249645Medicaid
2123368OtherPK
NJ0245810Medicaid