Provider Demographics
NPI:1558633230
Name:KHAN, AMIR T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:T
Last Name:KHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5863 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1930
Mailing Address - Country:US
Mailing Address - Phone:209-471-5426
Mailing Address - Fax:209-477-7111
Practice Address - Street 1:2339 W HAMMER LN STE J
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2368
Practice Address - Country:US
Practice Address - Phone:209-471-7100
Practice Address - Fax:209-471-7111
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14304183500000X
CA51125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist