Provider Demographics
NPI:1033889407
Name:ABTAHI, SHERVIN (RPH)
Entity Type:Individual
Prefix:
First Name:SHERVIN
Middle Name:
Last Name:ABTAHI
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 1:7012 ALDER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3844
Mailing Address - Country:US
Mailing Address - Phone:916-749-9538
Mailing Address - Fax:
Practice Address - Street 1:7012 ALDER CREEK RD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3844
Practice Address - Country:US
Practice Address - Phone:916-749-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist