Provider Demographics
NPI:1417522038
Name:FATHOLAHI, KEVIN ZACHARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ZACHARY
Last Name:FATHOLAHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VILLAGE DR APT 719
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2890
Mailing Address - Country:US
Mailing Address - Phone:978-758-4667
Mailing Address - Fax:
Practice Address - Street 1:1200 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8429
Practice Address - Country:US
Practice Address - Phone:610-399-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist