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NPI Code Detail

MEDICARE: DR. KETAYOUN DAVARI PHARM.D.

MEDICARE: DR. KETAYOUN DAVARI PHARM.D.
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
11835P1200XPharmacotherapy PharmacistRPH019071GA

General Provider Information

NPI Number : 1356342042
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KETAYOUN DAVARI PHARM.D.
Provider Business Mailing Address
First Line : 12130 LEEWARD WALK CIR
Second Line :
City : ALPHARETTA
State : GA
Zip : 30005-7478
Country : US
Telephone Number : 678-525-2019
Fax Number :
Provider Business Practice Location Address
First Line : 1670 CLAIRMONT RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-4004
Country : US
Telephone Number : 404-321-6111
Fax Number : 404-417-2936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 07/08/2007

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