Provider Demographics
NPI:1821848342
Name:KHAN, TAHIRA N/A
Entity Type:Individual
Prefix:
First Name:TAHIRA
Middle Name:N/A
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 N CENTRAL EXPY STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6943
Mailing Address - Country:US
Mailing Address - Phone:469-825-6061
Mailing Address - Fax:469-825-6062
Practice Address - Street 1:1915 N CENTRAL EXPY STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6943
Practice Address - Country:US
Practice Address - Phone:469-825-6061
Practice Address - Fax:469-825-6062
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016106183500000X
TX73580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist