Provider Demographics
NPI:1437365285
Name:SHIRAKBARI, NASSER - (PD)
Entity Type:Individual
Prefix:MR
First Name:NASSER
Middle Name:-
Last Name:SHIRAKBARI
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SIDLAW HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-4801
Mailing Address - Country:US
Mailing Address - Phone:479-876-1284
Mailing Address - Fax:479-876-1284
Practice Address - Street 1:198 N CURTIS AVE
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-3407
Practice Address - Country:US
Practice Address - Phone:479-451-8400
Practice Address - Fax:479-451-8403
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist