Provider Demographics
NPI:1083234140
Name:KHAN, ABDUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:KHAN
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 1:323 ARBORETUM DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-7111
Mailing Address - Country:US
Mailing Address - Phone:630-890-6748
Mailing Address - Fax:
Practice Address - Street 1:21000 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1935
Practice Address - Country:US
Practice Address - Phone:708-898-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist