Provider Demographics
NPI:1730436775
Name:KHAN, IMRAN (RPH)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5112
Mailing Address - Country:US
Mailing Address - Phone:407-370-6742
Mailing Address - Fax:407-345-5463
Practice Address - Street 1:7650 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5112
Practice Address - Country:US
Practice Address - Phone:407-370-6742
Practice Address - Fax:407-345-5463
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist