Provider Demographics
NPI:1982258836
Name:KHAN, SHAWAN MEHDI (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHAWAN
Middle Name:MEHDI
Last Name:KHAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 TITTABAWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9433
Mailing Address - Country:US
Mailing Address - Phone:989-793-5701
Mailing Address - Fax:989-484-9263
Practice Address - Street 1:800 LEONARD ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4148
Practice Address - Country:US
Practice Address - Phone:616-458-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist