Provider Demographics
NPI:1033736145
Name:HAKIMIAN, MISAGH (RPH)
Entity Type:Individual
Prefix:
First Name:MISAGH
Middle Name:
Last Name:HAKIMIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17425 N 19TH AVE APT 2196
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-2430
Mailing Address - Country:US
Mailing Address - Phone:765-343-2426
Mailing Address - Fax:
Practice Address - Street 1:3975 E THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5711
Practice Address - Country:US
Practice Address - Phone:602-923-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist