Provider Demographics
NPI:1861678567
Name:KHAN, MOHAMMAD DELWAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:DELWAR
Last Name:KHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 101ST AVE
Mailing Address - Street 2:AN-NOOR PHARMACY INC.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3404
Mailing Address - Country:US
Mailing Address - Phone:718-827-4000
Mailing Address - Fax:718-827-4001
Practice Address - Street 1:35 101ST AVE
Practice Address - Street 2:AN-NOOR PHARMACY INC.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3404
Practice Address - Country:US
Practice Address - Phone:718-827-4000
Practice Address - Fax:718-827-4001
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist