Provider Demographics
NPI:1225352545
Name:KHAN, MOHAMMAD SHEHZAD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:SHEHZAD
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:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:12758-1420
Mailing Address - Country:US
Mailing Address - Phone:845-439-1188
Mailing Address - Fax:845-439-1194
Practice Address - Street 1:43A MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON MANOR
Practice Address - State:NY
Practice Address - Zip Code:12758-5145
Practice Address - Country:US
Practice Address - Phone:845-439-1188
Practice Address - Fax:845-439-1194
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042752OtherPHARMACIST LICENCE