Provider Demographics
NPI:1477145340
Name:MOSHKELANI, MEHRAN
Entity Type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:MOSHKELANI
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 1:4713 RAY ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-3071
Mailing Address - Country:US
Mailing Address - Phone:469-569-2895
Mailing Address - Fax:
Practice Address - Street 1:110 S SW LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-6508
Practice Address - Country:US
Practice Address - Phone:903-526-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist