Healthcare Provider Details

I. General information

NPI: 1609798297
Provider Name (Legal Business Name): SHAYAN IMANPOUR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAWN IMANPOUR PHARMD

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W LAKE LANSING RD
EAST LANSING MI
48823-1300
US

IV. Provider business mailing address

2017 NORTHAMPTON WAY
LANSING MI
48912-3527
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-3010
  • Fax:
Mailing address:
  • Phone: 517-333-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302419089
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: