Provider Demographics
NPI:1013542133
Name:ROSHAN, ARMIN
Entity Type:Individual
Prefix:
First Name:ARMIN
Middle Name:
Last Name:ROSHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11507 HARE TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1822
Mailing Address - Country:US
Mailing Address - Phone:512-331-6615
Mailing Address - Fax:
Practice Address - Street 1:1615 GRAND AVENUE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2060
Practice Address - Country:US
Practice Address - Phone:512-377-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist