Provider Demographics
NPI:1144234568
Name:HARIRI, MEHRDAD (RPH)
Entity Type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:HARIRI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5809
Mailing Address - Country:US
Mailing Address - Phone:407-383-3301
Mailing Address - Fax:
Practice Address - Street 1:77 CYPRESS LN
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5809
Practice Address - Country:US
Practice Address - Phone:407-383-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist