Provider Demographics
NPI:1568748457
Name:KHAN, TASMIYA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TASMIYA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 28TH ST
Mailing Address - Street 2:9TH FLOOR, CN-46
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4131
Mailing Address - Country:US
Mailing Address - Phone:347-396-4268
Mailing Address - Fax:
Practice Address - Street 1:4209 28TH ST
Practice Address - Street 2:9TH FLOOR, CN-46
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4131
Practice Address - Country:US
Practice Address - Phone:347-396-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 056112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist