Provider Demographics
NPI:1679810543
Name:KHAN, MOHSIN ALI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MOHSIN
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 WELLINGTON SHORES DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8349
Mailing Address - Country:US
Mailing Address - Phone:561-670-0640
Mailing Address - Fax:
Practice Address - Street 1:5970 S JOG RD
Practice Address - Street 2:
Practice Address - City:LLAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-649-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0023692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist