Provider Demographics
NPI:1902445638
Name:KHAN, SADIA TARIQ (RPH)
Entity Type:Individual
Prefix:
First Name:SADIA
Middle Name:TARIQ
Last Name:KHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 SHEEPSHEAD BAY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3804
Mailing Address - Country:US
Mailing Address - Phone:718-934-3838
Mailing Address - Fax:718-648-9457
Practice Address - Street 1:1653 SHEEPSHEAD BAY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3804
Practice Address - Country:US
Practice Address - Phone:718-934-3838
Practice Address - Fax:718-648-9457
Is Sole Proprietor?:No
Enumeration Date:2019-12-28
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024430183500000X
NY065188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist