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General NPI Number Information
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NPI Number | 1174820922
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Entity Type | Individual
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Provider Name | MOHAMMED IQBAL KHAN RPH
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Gender | Male
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 3457 BOSTON ROAD SUPER VALUE PHARMACY
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City | BRONX
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State | NY
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Zip | 10469
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Country | US
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Telephone | 718-881-2260
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Fax | 718-515-7826
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Provider Business Mailing Address
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Address Line | 8916 175TH ST APT 5A
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City | JAMAICA
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State | NY
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Zip | 11432-5549
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Country | US
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Telephone | 347-612-2997
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 042687
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License Number State | NY
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