Healthcare Provider Details

I. General information

NPI: 1194389445
Provider Name (Legal Business Name): SHANT OHANGHARAGHIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3782 SPOONBILL WAY
TURLOCK CA
95382-8557
US

IV. Provider business mailing address

3782 SPOONBILL WAY
TURLOCK CA
95382-8557
US

V. Phone/Fax

Practice location:
  • Phone: 209-620-4311
  • Fax:
Mailing address:
  • Phone: 209-620-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number80322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: