Provider Demographics
NPI:1508069675
Name:MIRZAYAN, PATRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MIRZAYAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3546 S BRICE CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-1923
Mailing Address - Country:US
Mailing Address - Phone:717-682-8708
Mailing Address - Fax:
Practice Address - Street 1:51 W 3RD ST
Practice Address - Street 2:SUITE 501
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2831
Practice Address - Country:US
Practice Address - Phone:480-317-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14408183500000X
PARP438444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist