Provider Demographics
NPI:1053662718
Name:REZAEI, SAHAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:REZAEI
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 1:32 ROSE TRELLIS
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0172
Mailing Address - Country:US
Mailing Address - Phone:714-310-4120
Mailing Address - Fax:
Practice Address - Street 1:2300 PARK AVE
Practice Address - Street 2:T2151
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-2702
Practice Address - Country:US
Practice Address - Phone:714-361-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist