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General NPI Number Information
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NPI Number | 1912719352
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Entity Type | Individual
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Provider Name | SHIRIN M KHADIVI RPH
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 5810 TRADE CENTER DR
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City | AUSTIN
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State | TX
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Zip | 78744-1368
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Country | US
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Telephone | 512-383-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 5810 TRADE CENTER DR STE 300
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City | AUSTIN
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State | TX
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Zip | 78744-1365
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Country | US
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Telephone | 512-383-9229
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 25077
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License Number State | TX
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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 | 48148
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License Number State | TX
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