Provider Demographics
NPI:1376274647
Name:DEHGHAN KELISHADI, SAHAR (RPH)
Entity Type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:DEHGHAN KELISHADI
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 1:600 MINNESOTA ST APT 529
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3027
Mailing Address - Country:US
Mailing Address - Phone:415-217-9461
Mailing Address - Fax:
Practice Address - Street 1:600 MINNESOTA ST APT 529
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3027
Practice Address - Country:US
Practice Address - Phone:415-217-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist