Healthcare Provider Details

I. General information

NPI: 1760784276
Provider Name (Legal Business Name): NASRIN MEHDIZADEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10111 RICHMOND AVE SUITE 400
HOUSTON TX
77042-4215
US

IV. Provider business mailing address

10111 RICHMOND AVE SUITE 400
HOUSTON TX
77042-4215
US

V. Phone/Fax

Practice location:
  • Phone: 713-581-7079
  • Fax:
Mailing address:
  • Phone: 281-240-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number175979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: