Provider Demographics
NPI:1295221323
Name:SHEHZAD, KHURRAM (PHARMD)
Entity type:Individual
Prefix:MR
First Name:KHURRAM
Middle Name:
Last Name:SHEHZAD
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 1:3818 DURAND AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4425
Mailing Address - Country:US
Mailing Address - Phone:954-336-7502
Mailing Address - Fax:262-770-5618
Practice Address - Street 1:3818 DURAND AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4425
Practice Address - Country:US
Practice Address - Phone:954-336-7502
Practice Address - Fax:262-770-2618
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2023-03-27
Deactivation Date:2021-10-19
Deactivation Code:
Reactivation Date:2022-08-04
Provider Licenses
StateLicense IDTaxonomies
WI15476-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist