Healthcare Provider Details

I. General information

NPI: 1548912215
Provider Name (Legal Business Name): DAVID H SHAHNOOSHI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 S PARK AVE STE 805
TUCSON AZ
85713-5042
US

IV. Provider business mailing address

3690 S PARK AVE STE 805
TUCSON AZ
85713-5042
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-6760
  • Fax:
Mailing address:
  • Phone: 970-433-1629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024107
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: