Healthcare Provider Details

I. General information

NPI: 1396077905
Provider Name (Legal Business Name): SAMAN KHAN PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2010
Last Update Date: 02/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FAIRCHILD AVE SUITE 100
PLAINVIEW NY
11803-1727
US

IV. Provider business mailing address

25 FAIRCHILD AVE SUITE 100
PLAINVIEW NY
11803-1727
US

V. Phone/Fax

Practice location:
  • Phone: 516-349-8001
  • Fax: 516-349-7980
Mailing address:
  • Phone: 516-349-8001
  • Fax: 516-349-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052017
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: