=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952710659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOHEIL AHGHARI RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2014
-----------------------------------------------------
Last Update Date | 08/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2067 W VISTA WAY STE 195
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-631-1010
-----------------------------------------------------
Fax | 760-758-7612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 818 WILD LILAC CIR
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92078-7942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-699-2448
-----------------------------------------------------
Fax | 760-758-7612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 52296
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------