Healthcare Provider Details

I. General information

NPI: 1225352545
Provider Name (Legal Business Name): MOHAMMAD SHEHZAD KHAN R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 10/21/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43A MAIN ST
LIVINGSTON MANOR NY
12758-5145
US

IV. Provider business mailing address

PO BOX 1420
LIVINGSTON MANOR NY
12758-1420
US

V. Phone/Fax

Practice location:
  • Phone: 845-439-1188
  • Fax: 845-439-1194
Mailing address:
  • Phone: 845-439-1188
  • Fax: 845-439-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: