Provider Demographics
NPI:1689047763
Name:KHANDEKAR, AHMED S
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:S
Last Name:KHANDEKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 WESTCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4319
Mailing Address - Country:US
Mailing Address - Phone:817-263-0962
Mailing Address - Fax:
Practice Address - Street 1:6205 WESTCREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4319
Practice Address - Country:US
Practice Address - Phone:817-263-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist