MEDICARE: REZA MOHAMMAD SAFARPOUR RPH

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	2797369-1701	UT
2	183500000X	Pharmacist	PH00022047	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2797369	OTHER	UT	STATE LICENSE NUMBER
2	PH00022047	OTHER	WA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1942278395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REZA MOHAMMAD SAFARPOUR RPH

Provider Business Mailing Address
First Line	:	4111 JUPITER DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3341
Country	:	US
Telephone Number	:	801-272-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	4111 JUPITER DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3341
Country	:	US
Telephone Number	:	801-272-0550
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	12/13/2010

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Directions to “ REZA MOHAMMAD SAFARPOUR RPH” Practice Location

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