Provider Demographics
NPI:1336693092
Name:LAVASSANI, ALIREZA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:LAVASSANI
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 1:195 SADDLE BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8128
Mailing Address - Country:US
Mailing Address - Phone:404-587-8099
Mailing Address - Fax:
Practice Address - Street 1:3970 PEACHTREE INDUSTRIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30096-4813
Practice Address - Country:US
Practice Address - Phone:404-633-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist