MEDICARE: MASOUMEH MACI BAKHTIARI

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	183500000X	Pharmacist	75027	TX

General Provider Information

NPI Number	:	1184440745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASOUMEH MACI BAKHTIARI

Provider Business Mailing Address
First Line	:	2338 HARVEY MITCHELL PKWY S APT 9201
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5187
Country	:	US
Telephone Number	:	979-739-8517
Fax Number	:

Provider Business Practice Location Address
First Line	:	1296 ARRINGTON RD
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8683
Country	:	US
Telephone Number	:	979-207-6333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2024
Last Update Date	:	12/04/2025

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Directions to “ MASOUMEH MACI BAKHTIARI ” Practice Location

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