Healthcare Provider Details

I. General information

NPI: 1215077888
Provider Name (Legal Business Name): SIAMAK KIANI KEIVAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9411 DYER ST STE A
EL PASO TX
79924-6407
US

IV. Provider business mailing address

PO BOX 4850
EL PASO TX
79914-4850
US

V. Phone/Fax

Practice location:
  • Phone: 915-400-9900
  • Fax: 915-400-9600
Mailing address:
  • Phone: 915-400-9900
  • Fax: 915-400-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: