Provider Demographics
NPI:1033289178
Name:TAVAKOLI, GHAZALEH (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:GHAZALEH
Middle Name:
Last Name:TAVAKOLI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 WALES CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2383
Mailing Address - Country:US
Mailing Address - Phone:408-532-0552
Mailing Address - Fax:
Practice Address - Street 1:275 HOSPITAL PKWY STE 625
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1141
Practice Address - Country:US
Practice Address - Phone:408-363-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 45714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist