Provider Demographics
NPI:1346986536
Name:MOSTAAN, ROYA (RPH)
Entity Type:Individual
Prefix:MS
First Name:ROYA
Middle Name:
Last Name:MOSTAAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13268 ANTHONY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-5148
Mailing Address - Country:US
Mailing Address - Phone:949-813-0645
Mailing Address - Fax:
Practice Address - Street 1:13268 ANTHONY RIDGE RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-5148
Practice Address - Country:US
Practice Address - Phone:949-814-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist