Provider Demographics
NPI:1073886032
Name:ILIAIFAR, SEYEDEH FAYE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SEYEDEH
Middle Name:FAYE
Last Name:ILIAIFAR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:FAYE
Other - Middle Name:
Other - Last Name:ILIAIFAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:7404 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5528
Mailing Address - Country:US
Mailing Address - Phone:503-286-6784
Mailing Address - Fax:503-286-6792
Practice Address - Street 1:7404 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5528
Practice Address - Country:US
Practice Address - Phone:503-286-6784
Practice Address - Fax:503-286-6792
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist