Provider Demographics
NPI:1174820922
Name:KHAN, MOHAMMED IQBAL (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMED
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 1:8916 175TH ST
Mailing Address - Street 2:APT 5A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5549
Mailing Address - Country:US
Mailing Address - Phone:347-612-2997
Mailing Address - Fax:
Practice Address - Street 1:3457 BOSTON ROAD
Practice Address - Street 2:SUPER VALUE PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469
Practice Address - Country:US
Practice Address - Phone:718-881-2260
Practice Address - Fax:718-515-7826
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist