Healthcare Provider Details

I. General information

NPI: 1053400911
Provider Name (Legal Business Name): DR. AMIR TABRIZIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

1432 BURINIG TREE ROAD
CHARLESTON SC
29412
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-6583
  • Fax: 843-789-7672
Mailing address:
  • Phone: 843-406-0705
  • Fax: 843-406-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008872
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: