MEDICARE: GINA VICTOR FARID MOFTAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S025008	AZ
2	183500000X	Pharmacist	68436	TX
3	183500000X	Pharmacist	RPH87652	CA

General Provider Information

NPI Number	:	1265396477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA VICTOR FARID MOFTAH

Provider Business Mailing Address
First Line	:	5733 N CAMINO DE LAS ESTRELLAS
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5733 N CAMINO DE LAS ESTRELLAS
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4424
Country	:	US
Telephone Number	:	480-431-5170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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