Healthcare Provider Details

I. General information

NPI: 1245160589
Provider Name (Legal Business Name): ALI REZA MOSALLAEI KAZEROUNIAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9237 SNOWRIDGE CT NE
ALBUQUERQUE NM
87111-2440
US

IV. Provider business mailing address

9237 SNOWRIDGE CT NE
ALBUQUERQUE NM
87111-2440
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-2012
  • Fax:
Mailing address:
  • Phone: 505-463-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006487
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: