Provider Demographics
NPI:1114308897
Name:ZIAEE, AMIR
Entity Type:Individual
Prefix:MR
First Name:AMIR
Middle Name:
Last Name:ZIAEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 S MAIN ST
Mailing Address - Street 2:SAFEWAY PHARMACY 0965
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:845 S MAIN ST
Practice Address - Street 2:SAFEWAY PHARMACY 0965
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-3915
Practice Address - Country:US
Practice Address - Phone:707-456-1790
Practice Address - Fax:707-456-1794
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist