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General NPI Number Information
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NPI Number | 1558235804
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Entity Type | Individual
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Provider Name | YASER N/A GHAVAMI
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Gender | Male
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Dates
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Enumeration Date | 09/30/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 3240 US HIGHWAY 50 E
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City | CARSON CITY
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State | NV
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Zip | 89701-2801
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Country | US
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Telephone | 775-883-7011
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Fax |
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Provider Business Mailing Address
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Address Line | 11627 N DAVIS RD
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City | LODI
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State | CA
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Zip | 95242-9543
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Country | US
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Telephone | 209-954-6772
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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 | 03445918
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License Number State | OH
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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 | 24784
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License Number State | NV
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