Provider Demographics
NPI:1245514272
Name:KHAN, ANEES UNISA (REGESTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:ANEES
Middle Name:UNISA
Last Name:KHAN
Suffix:
Gender:F
Credentials:REGESTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24801 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5413
Mailing Address - Country:US
Mailing Address - Phone:815-577-1039
Mailing Address - Fax:815-577-1701
Practice Address - Street 1:24801 W 135TH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5413
Practice Address - Country:US
Practice Address - Phone:815-577-1039
Practice Address - Fax:815-577-1701
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-287193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist