Provider Demographics
NPI:1871200188
Name:KHALIL, MARTINA MORKOS (RPH)
Entity type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:MORKOS
Last Name:KHALIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 VALLEY RIDGE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-4054
Mailing Address - Country:US
Mailing Address - Phone:248-508-3280
Mailing Address - Fax:
Practice Address - Street 1:1013 S KALAMAZOO ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-8258
Practice Address - Country:US
Practice Address - Phone:269-415-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist