Healthcare Provider Details

I. General information

NPI: 1598500654
Provider Name (Legal Business Name): AQIB IQBAL KHAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 17TH ST
MODESTO CA
95354-1209
US

IV. Provider business mailing address

10383 POINT REYES CIR
STOCKTON CA
95209-4153
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7700
  • Fax:
Mailing address:
  • Phone: 209-670-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: