Provider Demographics
NPI:1508453515
Name:MOHEBBI, NILOUFAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:NILOUFAR
Middle Name:
Last Name:MOHEBBI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NELLIE
Other - Middle Name:
Other - Last Name:MOHEBBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11450 LAMAR AVE UNIT 2403
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1569
Mailing Address - Country:US
Mailing Address - Phone:913-244-0389
Mailing Address - Fax:
Practice Address - Street 1:18101 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9532
Practice Address - Country:US
Practice Address - Phone:913-393-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-100750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist