Provider Demographics
NPI:1386427185
Name:KHOULANI, MNOWAR
Entity type:Individual
Prefix:
First Name:MNOWAR
Middle Name:
Last Name:KHOULANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 LAKE KNOLL DR NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8710
Mailing Address - Country:US
Mailing Address - Phone:404-424-3769
Mailing Address - Fax:
Practice Address - Street 1:723 LAKE KNOLL DR NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8710
Practice Address - Country:US
Practice Address - Phone:404-424-3769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist