Provider Demographics
NPI:1467031609
Name:MALEKI, PARASTOU
Entity Type:Individual
Prefix:
First Name:PARASTOU
Middle Name:
Last Name:MALEKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 LUNDIN LINKS CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2475
Mailing Address - Country:US
Mailing Address - Phone:770-310-0086
Mailing Address - Fax:
Practice Address - Street 1:815 LUNDIN LINKS CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2475
Practice Address - Country:US
Practice Address - Phone:770-310-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist