Provider Demographics
NPI:1114106085
Name:KHAN, MOHAMMAD IQBAL (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:IQBAL
Last Name:KHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BATH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4813
Mailing Address - Country:US
Mailing Address - Phone:718-266-2266
Mailing Address - Fax:718-266-2289
Practice Address - Street 1:2001 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4813
Practice Address - Country:US
Practice Address - Phone:718-266-2266
Practice Address - Fax:718-266-2289
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist