Provider Demographics
NPI:1306150479
Name:KHAN, ABDUL MUSAWWIR
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:MUSAWWIR
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18444 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2112
Mailing Address - Country:US
Mailing Address - Phone:818-349-6267
Mailing Address - Fax:
Practice Address - Street 1:18444 PLUMMER ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2112
Practice Address - Country:US
Practice Address - Phone:818-349-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-01
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH47940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist