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General NPI Number Information
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NPI Number | 1548664261
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Entity Type | Individual
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Provider Name | LISA MOSTAFAVIFAR PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 410 W 10TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210-1240
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Country | US
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Telephone | 614-366-7821
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Fax |
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Provider Business Mailing Address
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Address Line | 410 W 10TH AVENUE
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City | COLUMBUS
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State | OH
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Zip | 43210-3696
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Country | US
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Telephone | 614-366-7821
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 03230809
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RP0007102
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PS44772
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License Number State | FL
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