Provider Demographics
NPI:1629391479
Name:KHAN, KHALID MAHMOOD (RPH)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:MAHMOOD
Last Name:KHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:KHALID
Other - Middle Name:
Other - Last Name:MAHMOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-5205
Mailing Address - Country:US
Mailing Address - Phone:845-692-2223
Mailing Address - Fax:
Practice Address - Street 1:79 FULTON ST
Practice Address - Street 2:RITEAID PHARMACY
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5247
Practice Address - Country:US
Practice Address - Phone:845-343-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist