MEDICARE: MAHAM KHAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PCT.0014230	CT

General Provider Information

NPI Number	:	1285132449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHAM KHAN RPH

Provider Business Mailing Address
First Line	:	19 BARRY CIR
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-1967
Country	:	US
Telephone Number	:	203-450-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 BARRY CIR
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-1967
Country	:	US
Telephone Number	:	203-450-3520
Fax Number	:	203-450-3520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/23/2018

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