MEDICARE: KHOSROW PEZESHKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	27421	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5903186	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1073805230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHOSROW PEZESHKI

Provider Business Mailing Address
First Line	:	7563 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1423
Country	:	US
Telephone Number	:	713-271-2108
Fax Number	:	713-271-2110

Provider Business Practice Location Address
First Line	:	7563 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1423
Country	:	US
Telephone Number	:	713-271-2108
Fax Number	:	713-271-2110

Authorized Official
Title or Position	:	PHARMACIST-PIC
Name	:	BOBBY JONES
Credential	:
Telephone Number	:	713-271-2108

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	05/20/2011

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Directions to “KHOSROW PEZESHKI ” Practice Location

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