Provider Demographics
NPI:1477141794
Name:MOVAHED, PAYAM (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:MOVAHED
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 ALLEGHENY TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4412
Mailing Address - Country:US
Mailing Address - Phone:972-762-4921
Mailing Address - Fax:
Practice Address - Street 1:5819 BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1114
Practice Address - Country:US
Practice Address - Phone:512-687-2212
Practice Address - Fax:512-687-2218
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist