MEDICARE: SUMAIYA 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	PS46937	FL

General Provider Information

NPI Number	:	1972934024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMAIYA KHAN

Provider Business Mailing Address
First Line	:	10212 GARDEN ALCOVE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12210 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-9211
Country	:	US
Telephone Number	:	813-972-2000
Fax Number	:

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

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/27/2013

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