Healthcare Provider Details

I. General information

NPI: 1265439681
Provider Name (Legal Business Name): LALEH TAHERI VARASTEH RPH, MSF
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VAN DE GRAAFF DR
BURLINGTON MA
01803-5174
US

IV. Provider business mailing address

291 OAKLAND ST
WELLESLEY MA
02481-6806
US

V. Phone/Fax

Practice location:
  • Phone: 781-425-6665
  • Fax: 781-229-8878
Mailing address:
  • Phone: 781-235-3220
  • Fax: 781-229-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19979
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: