Provider Demographics
NPI:1437460920
Name:KHANZADEH, HOSSEIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:KHANZADEH
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 1:2115 GOLDEN CENTRE LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4477
Mailing Address - Country:US
Mailing Address - Phone:714-305-8915
Mailing Address - Fax:916-852-1736
Practice Address - Street 1:2115 GOLDEN CENTRE LN
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4477
Practice Address - Country:US
Practice Address - Phone:714-305-8915
Practice Address - Fax:916-852-1736
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 44191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist