Healthcare Provider Details

I. General information

NPI: 1831662675
Provider Name (Legal Business Name): ALIREZA ALIABADI PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 FRANKLIN BLVD
LEMOORE CA
93246-4700
US

IV. Provider business mailing address

6020 VIA MADRID
GRANITE BAY CA
95746-5801
US

V. Phone/Fax

Practice location:
  • Phone: 559-998-4299
  • Fax:
Mailing address:
  • Phone: 530-400-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023611
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: