Provider Demographics
NPI:1750044152
Name:KHAN, HAROON (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:HAROON
Middle Name:
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 1:711 AYERS ST
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-9045
Mailing Address - Country:US
Mailing Address - Phone:616-540-3813
Mailing Address - Fax:
Practice Address - Street 1:711 AYERS ST
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-9045
Practice Address - Country:US
Practice Address - Phone:616-540-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist