MEDICARE: DR. MOHAMMED TARIQ 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	42778	TX

General Provider Information

NPI Number	:	1265037576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMED TARIQ KHAN PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 830496
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75083-0496
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11820 ELAM RD
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-2746
Country	:	US
Telephone Number	:	972-286-3530
Fax Number	:

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

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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