Healthcare Provider Details

I. General information

NPI: 1992448567
Provider Name (Legal Business Name): PARISA VAZIRI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 GOLD STAR HWY
GROTON CT
06340-3429
US

IV. Provider business mailing address

79 GOLD STAR HWY
GROTON CT
06340-3429
US

V. Phone/Fax

Practice location:
  • Phone: 860-381-4240
  • Fax:
Mailing address:
  • Phone: 860-381-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015598
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: