Provider Demographics
NPI:1952728909
Name:KHAN, OMAR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2706
Mailing Address - Country:US
Mailing Address - Phone:828-236-1519
Mailing Address - Fax:828-236-1522
Practice Address - Street 1:1124 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2706
Practice Address - Country:US
Practice Address - Phone:828-236-1519
Practice Address - Fax:828-236-1522
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist