Provider Demographics
NPI:1386958015
Name:KHAN, SHAMIALA
Entity type:Individual
Prefix:MRS
First Name:SHAMIALA
Middle Name:
Last Name:KHAN
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 1:314 APPLEGARTH RD
Mailing Address - Street 2:STORE # 10521
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3738
Mailing Address - Country:US
Mailing Address - Phone:609-655-3101
Mailing Address - Fax:
Practice Address - Street 1:314 APPLEGARTH RD
Practice Address - Street 2:STORE # 10521
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3738
Practice Address - Country:US
Practice Address - Phone:609-655-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03273600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist