Healthcare Provider Details

I. General information

NPI: 1487055612
Provider Name (Legal Business Name): KAVE NIKBAKHT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ZELKOVA CT. WAL-MART PHARMACY
CONOVER NC
28613
US

IV. Provider business mailing address

201 ZELKOVA CT. WAL-MART PHARMACY
CONOVER NC
28613
US

V. Phone/Fax

Practice location:
  • Phone: 828-464-4700
  • Fax: 828-464-4535
Mailing address:
  • Phone: 828-464-4700
  • Fax: 828-464-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberNC15524
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: