Individual provider Active NPI

Mohammed Iqbal Khan, RPH

  • Pharmacist
  • Bronx, NY
National Provider Identifier
1174820922
Registry record updated Feb 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
042687 Issued in NY
Practice address
3457 Boston Road
Super Value Pharmacy
Bronx, NY 10469
Phone
(718) 881-2260
Fax
(718) 515-7826
NPI assigned
Feb 14, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 042687 NY Primary

Addresses

Primary practice location

3457 Boston Road
Super Value Pharmacy
Bronx, NY 10469

Mailing address

8916 175TH St
Apt 5a
Jamaica, NY 11432-5549
Phone (347) 612-2997

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297641600000",
    "number": "1174820922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8916 175TH ST",
            "address_2": "APT 5A",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114325549",
            "telephone_number": "347-612-2997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3457 BOSTON ROAD",
            "address_2": "SUPER VALUE PHARMACY",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10469",
            "telephone_number": "718-881-2260",
            "fax_number": "718-515-7826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MOHAMMED",
        "middle_name": "IQBAL",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-14",
        "last_updated": "2011-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "042687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.