Provider Demographics
NPI:1073805230
Name:KHOSROW PEZESHKI
Entity Type:Organization
Organization Name:KHOSROW PEZESHKI
Other - Org Name:PHARMACY 2000
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-PIC
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-271-2108
Mailing Address - Street 1:7563 S BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1423
Mailing Address - Country:US
Mailing Address - Phone:713-271-2108
Mailing Address - Fax:713-271-2110
Practice Address - Street 1:7563 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-1423
Practice Address - Country:US
Practice Address - Phone:713-271-2108
Practice Address - Fax:713-271-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX274213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5903186OtherNCPDP PROVIDER IDENTIFICATION NUMBER