Provider Demographics
NPI:1699379891
Name:KHAN, AFZAV R
Entity Type:Individual
Prefix:
First Name:AFZAV
Middle Name:R
Last Name:KHAN
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 1:440 BELLEVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6719
Mailing Address - Country:US
Mailing Address - Phone:201-246-7231
Mailing Address - Fax:201-246-7236
Practice Address - Street 1:440 BELLEVILLE TPKE
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6719
Practice Address - Country:US
Practice Address - Phone:201-246-7231
Practice Address - Fax:201-246-7236
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03165600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist