Provider Demographics
NPI:1558515833
Name:KHAN, MADINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADINA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MADINA
Other - Middle Name:
Other - Last Name:NOURESTANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9371 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4005
Mailing Address - Country:US
Mailing Address - Phone:505-899-7731
Mailing Address - Fax:
Practice Address - Street 1:9371 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4005
Practice Address - Country:US
Practice Address - Phone:505-899-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007768183500000X
CA70640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist