Provider Demographics
NPI:1922554526
Name:KHONDAKER, AMANA
Entity Type:Individual
Prefix:
First Name:AMANA
Middle Name:
Last Name:KHONDAKER
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 1:2600 ANNAPOLIS RD.
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144
Mailing Address - Country:US
Mailing Address - Phone:410-799-2150
Mailing Address - Fax:
Practice Address - Street 1:2600 ANNAPOLIS RD.
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144
Practice Address - Country:US
Practice Address - Phone:410-799-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist