Provider Demographics
NPI:1366659625
Name:HAYATSHAHI, ALIREZA (PHARMD, BCPS, BCIDP)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:HAYATSHAHI
Suffix:
Gender:M
Credentials:PHARMD, BCPS, BCIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SONORA CIR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8509
Mailing Address - Country:US
Mailing Address - Phone:714-742-0795
Mailing Address - Fax:
Practice Address - Street 1:24745 STEWART STREET SHRYOCK HALL
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-6709
Practice Address - Country:US
Practice Address - Phone:909-558-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760111835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy