Provider Demographics
NPI:1003216029
Name:SOHEIL AHGHARI
Entity Type:Organization
Organization Name:SOHEIL AHGHARI
Other - Org Name:GREENFIELD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHGHARI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-842-1700
Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:STE#195
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-842-1700
Mailing Address - Fax:760-842-1745
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:STE#195
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-842-1700
Practice Address - Fax:760-842-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CA519433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147520OtherPK