Provider Demographics
NPI:1023735354
Name:TALHA, KHWAJA HARIS AHMED (RPH)
Entity type:Individual
Prefix:
First Name:KHWAJA
Middle Name:HARIS AHMED
Last Name:TALHA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S ADAMS ST APT 20
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2197
Mailing Address - Country:US
Mailing Address - Phone:443-388-3960
Mailing Address - Fax:
Practice Address - Street 1:1301 S ADAMS ST APT 20
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2197
Practice Address - Country:US
Practice Address - Phone:443-388-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030031A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W265140758OtherAETNA