Provider Demographics
NPI:1508198284
Name:KHAN, KEHKASHAN P
Entity Type:Individual
Prefix:
First Name:KEHKASHAN
Middle Name:P
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RED SCHOOLHOUSE RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7053
Mailing Address - Country:US
Mailing Address - Phone:845-371-8600
Mailing Address - Fax:
Practice Address - Street 1:80 RED SCHOOLHOUSE RD
Practice Address - Street 2:SUITE 226
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-7053
Practice Address - Country:US
Practice Address - Phone:845-371-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051357183500000X
NJ28RI02908900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist