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General NPI Number Information
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NPI Number | 1982258836
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Entity Type | Individual
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Provider Name | SHAWAN MEHDI KHAN PHARM. D.
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Gender | Male
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 02/23/2020
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Provider Practice Location Address
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Address Line | 800 LEONARD ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-4148
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Country | US
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Telephone | 616-458-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 2772 TITTABAWASSEE RD
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City | SAGINAW
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State | MI
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Zip | 48604-9433
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Country | US
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Telephone | 989-793-5701
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Fax | 989-484-9263
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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 | 5302045241
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License Number State | MI
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