Provider Demographics
NPI:1760568182
Name:KHAN, SERVAT (PHARM D)
Entity Type:Individual
Prefix:
First Name:SERVAT
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:SERVAT
Other - Middle Name:
Other - Last Name:MATEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:8746 KEDVALE AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2146
Mailing Address - Country:US
Mailing Address - Phone:312-569-7075
Mailing Address - Fax:312-569-6185
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-6885
Practice Address - Fax:312-569-6185
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology