Provider Demographics
NPI:1235856006
Name:TASHKHISI, PEJMAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PEJMAN
Middle Name:
Last Name:TASHKHISI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PUERTO AZUL TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8106
Mailing Address - Country:US
Mailing Address - Phone:310-866-8482
Mailing Address - Fax:
Practice Address - Street 1:2389 E WINDMILL LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2037
Practice Address - Country:US
Practice Address - Phone:702-837-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist