MEDICARE: BISMA KHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	52741	TX
2	183500000X	Pharmacist	26027655A	IN

General Provider Information

NPI Number	:	1174153928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BISMA KHAN

Provider Business Mailing Address
First Line	:	695 CENTRAL AVE STE 203
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-3662
Country	:	US
Telephone Number	:	866-234-9474
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 CENTRAL AVE STE 203
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-3662
Country	:	US
Telephone Number	:	866-234-9474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	01/21/2020

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Directions to “ BISMA KHAN ” Practice Location

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