Healthcare Provider Details

I. General information

NPI: 1003615261
Provider Name (Legal Business Name): SASON GHADERI MASIHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 102
PHOENIX AZ
85004-1829
US

IV. Provider business mailing address

7183 W HEDGE HOG PL
PEORIA AZ
85383-6407
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-1133
  • Fax: 602-257-1134
Mailing address:
  • Phone: 602-317-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026128
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: