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General NPI Number Information
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NPI Number | 1417468083
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Entity Type | Individual
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Provider Name | SHIVA SHIRVANIFAR
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Gender | Female
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 9830 W LOWER BUCKEYE RD
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City | TOLLESON
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State | AZ
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Zip | 85353-1401
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Country | US
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Telephone | 623-687-2137
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Fax |
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Provider Business Mailing Address
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Address Line | 4321 E COOLBROOK AVE
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City | PHOENIX
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State | AZ
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Zip | 85032-9212
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Country | US
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Telephone | 480-334-7234
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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 | 051.300263
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S022994
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License Number State | AZ
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