Provider Demographics
NPI:1598848913
Name:KHAN, MASOOD H (RPH)
Entity Type:Individual
Prefix:MR
First Name:MASOOD
Middle Name:H
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 1:545 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3538
Mailing Address - Country:US
Mailing Address - Phone:585-266-5685
Mailing Address - Fax:585-266-5689
Practice Address - Street 1:545 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3538
Practice Address - Country:US
Practice Address - Phone:585-266-5685
Practice Address - Fax:585-266-5689
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01188449Medicaid
NY0132660001Medicare UPIN
NM01188449Medicaid