Provider Demographics
NPI:1407451370
Name:ALIGHANBARI, VIDA
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:ALIGHANBARI
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 1:1612 E SILVER STAR RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2554
Mailing Address - Country:US
Mailing Address - Phone:407-294-7124
Mailing Address - Fax:407-297-7063
Practice Address - Street 1:1612 E SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2554
Practice Address - Country:US
Practice Address - Phone:407-294-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist