Healthcare Provider Details

I. General information

NPI: 1336664671
Provider Name (Legal Business Name): ASHAR T KHAN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14625 N GRAY RD
WESTFIELD IN
46062-9274
US

IV. Provider business mailing address

14625 N GRAY RD
WESTFIELD IN
46062-9274
US

V. Phone/Fax

Practice location:
  • Phone: 317-815-6619
  • Fax: 317-701-6635
Mailing address:
  • Phone: 317-815-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26027309A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: