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General NPI Number Information
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NPI Number | 1013514074
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Entity Type | Individual
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Provider Name | MIRZAALI VAGASLO MEHDIZADEH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 502 N VALLEY PKWY # 1A
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City | LEWISVILLE
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State | TX
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Zip | 75067-3437
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Country | US
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Telephone | 469-949-1003
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Fax | 469-949-1004
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Provider Business Mailing Address
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Address Line | 104 CRYSTAL CT
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City | RICHARDSON
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State | TX
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Zip | 75081-3543
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Country | US
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Telephone | 469-471-3375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 41673
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License Number State | TX
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