Provider Demographics
NPI:1164711628
Name:KHAN, ZAMAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZAMAN
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:PO BOX 1804
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1804
Mailing Address - Country:US
Mailing Address - Phone:209-712-7853
Mailing Address - Fax:209-368-7185
Practice Address - Street 1:115 E PINE ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-2210
Practice Address - Country:US
Practice Address - Phone:800-853-0651
Practice Address - Fax:800-985-9412
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488931835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48893OtherBOARD OF PHARMACY