Provider Demographics
NPI:1285221770
Name:KHANDELWAL, KARISHMA (RPH)
Entity Type:Individual
Prefix:
First Name:KARISHMA
Middle Name:
Last Name:KHANDELWAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 LINDEN STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66224
Mailing Address - Country:US
Mailing Address - Phone:913-832-4314
Mailing Address - Fax:
Practice Address - Street 1:2500 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4513
Practice Address - Country:US
Practice Address - Phone:913-727-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist