=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871925156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRIYANKA KHANNA PHARM.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2013
-----------------------------------------------------
Last Update Date | 08/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2235 SPRINGFIELD AVE 2141
-----------------------------------------------------
City | VAUXHALL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07088-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-622-9003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2235 SPRINGFIELD AVE 2141
-----------------------------------------------------
City | VAUXHALL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07088-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-622-9003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI03505700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------