Provider Demographics
NPI:1023982840
Name:KHAN, MOHAMMAD IMRAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:IMRAN
Last Name:KHAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10883 CORY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2992
Mailing Address - Country:US
Mailing Address - Phone:813-971-2459
Mailing Address - Fax:813-971-2980
Practice Address - Street 1:6206 COMMERCE PALMS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1506
Practice Address - Country:US
Practice Address - Phone:813-971-2459
Practice Address - Fax:813-971-2980
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist