Provider Demographics
NPI:1174164826
Name:KHAN, AMY SANDHU (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SANDHU
Last Name:KHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SANDHU
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1054 HOLBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5835
Mailing Address - Country:US
Mailing Address - Phone:734-730-6118
Mailing Address - Fax:
Practice Address - Street 1:5860 N CANTON CENTER RD STE 340
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2687
Practice Address - Country:US
Practice Address - Phone:734-730-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010121561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist