Provider Demographics
NPI:1184316457
Name:KHAN, HAYMISH (PHARMD)
Entity type:Individual
Prefix:
First Name:HAYMISH
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8265
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92615-8265
Mailing Address - Country:US
Mailing Address - Phone:562-209-2611
Mailing Address - Fax:
Practice Address - Street 1:1043 E 5TH ST APT 102
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1667
Practice Address - Country:US
Practice Address - Phone:562-370-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist