Healthcare Provider Details

I. General information

NPI: 1801071840
Provider Name (Legal Business Name): FARAH D KHAN PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ROUTE 211 E
MIDDLETOWN NY
10941-1413
US

IV. Provider business mailing address

701 ROUTE 211 E
MIDDLETOWN NY
10941-1413
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-2422
  • Fax: 845-692-3778
Mailing address:
  • Phone: 845-692-2422
  • Fax: 845-692-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047775-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: