Provider Demographics
NPI:1417194275
Name:KHAN, KAMRAN (RPH)
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
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 529
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-0529
Mailing Address - Country:US
Mailing Address - Phone:914-366-4000
Mailing Address - Fax:914-366-4036
Practice Address - Street 1:95 BEEKMAN AVE
Practice Address - Street 2:STE-D
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2549
Practice Address - Country:US
Practice Address - Phone:914-366-4000
Practice Address - Fax:914-366-4036
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist