Healthcare Provider Details

I. General information

NPI: 1548940216
Provider Name (Legal Business Name): RAZI APOTHECARY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 SESPE AVE
FILLMORE CA
93015-1957
US

IV. Provider business mailing address

552 SESPE AVE
FILLMORE CA
93015-1957
US

V. Phone/Fax

Practice location:
  • Phone: 805-419-2686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASMINE RAZEGHI
Title or Position: DIRECTOR
Credential:
Phone: 805-419-2686