Provider Demographics
NPI:1437589132
Name:AZAD, AZADEH (PHARMD)
Entity Type:Individual
Prefix:
First Name:AZADEH
Middle Name:
Last Name:AZAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 PIZARRO LN
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2950
Mailing Address - Country:US
Mailing Address - Phone:650-762-4353
Mailing Address - Fax:
Practice Address - Street 1:1030 PIZARRO LN
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2950
Practice Address - Country:US
Practice Address - Phone:650-762-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist