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General NPI Number Information
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NPI Number | 1265041537
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Entity Type | Individual
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Provider Name | SHIVA BAZARGAN PHARM D
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 3116 SR 34 WEST
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City | NEWNAN
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State | GA
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Zip | 30265
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Country | US
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Telephone | 678-423-1549
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Fax |
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Provider Business Mailing Address
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Address Line | 777 MEMORIAL DR SE APT 404
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City | ATLANTA
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State | GA
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Zip | 30316-1393
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Country | US
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Telephone |
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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 | RPH030366
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License Number State | GA
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