Healthcare Provider Details

I. General information

NPI: 1295055655
Provider Name (Legal Business Name): NAMVAR TAGHIPOUR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 EL CAJON BLVD
SAN DIEGO CA
92115-2646
US

IV. Provider business mailing address

14065 MANGO DR APT G
DEL MAR CA
92014-4916
US

V. Phone/Fax

Practice location:
  • Phone: 619-286-3470
  • Fax:
Mailing address:
  • Phone: 801-558-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: