MEDICARE: MAHNAZ SERAJI RPH

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	2701792311885581	UT
2	183500000X	Pharmacist	270179231188581894	UT

General Provider Information

NPI Number	:	1669159430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHNAZ SERAJI RPH

Provider Business Mailing Address
First Line	:	4974 S VALENE STREENT
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84117
Country	:	US
Telephone Number	:	801-467-0152
Fax Number	:	801-467-7729

Provider Business Practice Location Address
First Line	:	3250 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-1641
Country	:	US
Telephone Number	:	801-467-0152
Fax Number	:	801-467-7729

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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Directions to “ MAHNAZ SERAJI RPH” Practice Location

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