Provider Demographics
NPI:1093114167
Name:ETEMADI-SHALAMZ, BEHNAZ
Entity Type:Individual
Prefix:
First Name:BEHNAZ
Middle Name:
Last Name:ETEMADI-SHALAMZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3415
Mailing Address - Country:US
Mailing Address - Phone:504-466-6848
Mailing Address - Fax:
Practice Address - Street 1:3520 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3415
Practice Address - Country:US
Practice Address - Phone:504-466-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist