Healthcare Provider Details

I. General information

NPI: 1427057827
Provider Name (Legal Business Name): HAMID ALI KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 N.MAIN CASA DE AMIGO HEALTH CENTER PHARMACY
HOUSTON TX
77009
US

IV. Provider business mailing address

14322 DOUBLE SHOALS CIR
HOUSTON TX
77090-2478
US

V. Phone/Fax

Practice location:
  • Phone: 713-222-2272
  • Fax:
Mailing address:
  • Phone: 832-693-1440
  • Fax: 888-755-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: