Provider Demographics
NPI:1366046187
Name:TAHAJOUD, FATEMEH
Entity Type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:TAHAJOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-6202
Mailing Address - Country:US
Mailing Address - Phone:603-474-2514
Mailing Address - Fax:
Practice Address - Street 1:700 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-6202
Practice Address - Country:US
Practice Address - Phone:603-474-2514
Practice Address - Fax:603-474-2961
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist