Provider Demographics
NPI:1164770582
Name:MIRZAKAN, ARTY (RPH, PHARMD, MPH)
Entity Type:Individual
Prefix:
First Name:ARTY
Middle Name:
Last Name:MIRZAKAN
Suffix:
Gender:M
Credentials:RPH, PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24110 N 25TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-5248
Mailing Address - Country:US
Mailing Address - Phone:602-628-0731
Mailing Address - Fax:
Practice Address - Street 1:785 S COOPER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7160
Practice Address - Country:US
Practice Address - Phone:480-497-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist