MEDICARE: DR. SAFI M KHAN PHARMD

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	T-15771	MS
2	183500000X	Pharmacist	26026881A	IN
3	183500000X	Pharmacist	051300987	IL

General Provider Information

NPI Number	:	1245902618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAFI M KHAN PHARMD

Provider Business Mailing Address
First Line	:	6906 LYONS ST, MORTON GROVE, IL 60053
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053
Country	:	US
Telephone Number	:	773-829-5644
Fax Number	:

Provider Business Practice Location Address
First Line	:	6906 LYONS ST, MORTON GROVE, IL 60053
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053
Country	:	US
Telephone Number	:	773-829-5644
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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