Provider Demographics
NPI:1104054568
Name:KHAN, USMAN (PHARMD)
Entity type:Individual
Prefix:
First Name:USMAN
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 WOLVER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-4302
Mailing Address - Country:US
Mailing Address - Phone:516-621-3621
Mailing Address - Fax:
Practice Address - Street 1:9721 57TH AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3540
Practice Address - Country:US
Practice Address - Phone:718-699-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist