Healthcare Provider Details

I. General information

NPI: 1275082612
Provider Name (Legal Business Name): JAMSHID B TEHRANI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 FRANKFORD AVE
PHILADELPHIA PA
19135-2538
US

IV. Provider business mailing address

6519 FRANKFORD AVE
PHILADELPHIA PA
19135-2538
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-4224
  • Fax: 215-624-4416
Mailing address:
  • Phone: 215-624-4224
  • Fax: 215-624-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP028768L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP028768L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: