MEDICARE: AMANDA KHAN DOCTOR OF PHARMACY

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	E-13124	MS

General Provider Information

NPI Number	:	1548759525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KHAN DOCTOR OF PHARMACY

Provider Business Mailing Address
First Line	:	2856 HICKORY HILL RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2173
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2856 HICKORY HILL RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2173
Country	:	US
Telephone Number	:	901-362-3633
Fax Number	:

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

Provider Enumeration Date	:	05/06/2018
Last Update Date	:	05/06/2018

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