Basic Information
| Provider Information | |||||||||
| NPI: | 1083010326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELWAN | ||||||||
| FirstName: | KHALED | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1806 N STAR RD | ||||||||
| Address2: | C12 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432121565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148062607 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7625 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430169649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147171800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2014 | ||||||||
| LastUpdateDate: | 11/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03328235 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.