Provider Demographics
NPI:1093329682
Name:KHATABI, SHAGHAYEGH SHERRY
Entity Type:Individual
Prefix:
First Name:SHAGHAYEGH
Middle Name:SHERRY
Last Name:KHATABI
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 1:6650 E LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-7033
Mailing Address - Country:US
Mailing Address - Phone:702-438-2744
Mailing Address - Fax:
Practice Address - Street 1:6650 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-7033
Practice Address - Country:US
Practice Address - Phone:702-438-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR77918183500000X
NV19783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist