MEDICARE: SADIA TARIQ KHAN RPH

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	024430	NY
2	183500000X	Pharmacist	065188	NY

General Provider Information

NPI Number	:	1902445638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADIA TARIQ KHAN RPH

Provider Business Mailing Address
First Line	:	1653 SHEEPSHEAD BAY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3804
Country	:	US
Telephone Number	:	718-934-3838
Fax Number	:	718-648-9457

Provider Business Practice Location Address
First Line	:	1653 SHEEPSHEAD BAY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3804
Country	:	US
Telephone Number	:	718-934-3838
Fax Number	:	718-648-9457

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

Provider Enumeration Date	:	12/28/2019
Last Update Date	:	05/26/2022

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