Healthcare Provider Details

I. General information

NPI: 1730788613
Provider Name (Legal Business Name): GOLZAAR MAHDAVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 N WILLOW AVE
CLOVIS CA
93611-4408
US

IV. Provider business mailing address

1687 BEDFORD AVE
CLOVIS CA
93611-7383
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-0340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: