Provider Demographics
NPI:1144545492
Name:KHAN, MOHAMMAD USMAN ALI (B PHARM, RPH)
Entity type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:USMAN ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:B PHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:454 - 5TH AVENUE, 9TH STREET
Mailing Address - Street 2:NEERGAARD PHARMACIES
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:718-768-0660
Mailing Address - Fax:718-832-2912
Practice Address - Street 1:454 - 5TH AVENUE, 9TH STREET
Practice Address - Street 2:NEERGAARD PHARMACIES
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-768-0660
Practice Address - Fax:718-832-2912
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist