MEDICARE: MARJAN SARAH KHAZAELI PHARM.D., BCACP

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	121326	MN

General Provider Information

NPI Number	:	1861834871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJAN SARAH KHAZAELI PHARM.D., BCACP

Provider Business Mailing Address
First Line	:	401 S 1ST ST UNIT 506
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2563
Country	:	US
Telephone Number	:	651-402-3643
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 HIGHWAY 96 E
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55127-2557
Country	:	US
Telephone Number	:	651-326-5900
Fax Number	:

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

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	11/04/2020

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