Provider Demographics
NPI:1467227512
Name:FOROOTAN, KOOROSH
Entity Type:Individual
Prefix:
First Name:KOOROSH
Middle Name:
Last Name:FOROOTAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TREATY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5510
Mailing Address - Country:US
Mailing Address - Phone:610-505-8609
Mailing Address - Fax:
Practice Address - Street 1:45 TREATY DR
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5510
Practice Address - Country:US
Practice Address - Phone:610-505-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist