Provider Demographics
NPI:1831786847
Name:KHAZAN, OLIVIA (R PH, PHARMD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:KHAZAN
Suffix:
Gender:F
Credentials:R PH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 W 115TH ST STE 2511
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2205
Mailing Address - Country:US
Mailing Address - Phone:800-577-2812
Mailing Address - Fax:
Practice Address - Street 1:6800 W 115TH ST STE 2511
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2205
Practice Address - Country:US
Practice Address - Phone:800-577-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist