Provider Demographics
NPI:1174823124
Name:KHANNA, VIJAY KUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:VIJAY
Middle Name:KUMAR
Last Name:KHANNA
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 1:1610 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1139
Mailing Address - Country:US
Mailing Address - Phone:760-929-0287
Mailing Address - Fax:
Practice Address - Street 1:951 PALOMAR AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1110
Practice Address - Country:US
Practice Address - Phone:760-929-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist