Provider Demographics
NPI:1417242686
Name:MOSHTAGHI, SADIE KARIMI (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:KARIMI
Last Name:MOSHTAGHI
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81735
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92138-1735
Mailing Address - Country:US
Mailing Address - Phone:619-813-0458
Mailing Address - Fax:
Practice Address - Street 1:5923 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2711
Practice Address - Country:US
Practice Address - Phone:619-813-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75703183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician