Healthcare Provider Details

I. General information

NPI: 1154641512
Provider Name (Legal Business Name): NITASHA KHURANA B. SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 LOCKPORT ST
YOUNGSTOWN NY
14174-1008
US

IV. Provider business mailing address

PO BOX 3047
NIAGARA FALLS NY
14302-3047
US

V. Phone/Fax

Practice location:
  • Phone: 716-745-3313
  • Fax:
Mailing address:
  • Phone: 857-636-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number000062
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number441950
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24843
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: