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General NPI Number Information
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NPI Number | 1508633686
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Entity Type | Individual
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Provider Name | JAVAD BANIHASHEMI PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 8725 ROSWELL RD STE G
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City | ATLANTA
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State | GA
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Zip | 30350-7500
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Country | US
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Telephone | 770-640-5956
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Fax |
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Provider Business Mailing Address
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Address Line | 560 BESRA DR
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City | GRAYSON
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State | GA
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Zip | 30017-7948
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Country | US
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Telephone | 404-641-0010
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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 | RPH034679
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License Number State | GA
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