Provider Demographics
NPI:1508633686
Name:BANIHASHEMI, JAVAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAVAD
Middle Name:
Last Name:BANIHASHEMI
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 1:560 BESRA DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7948
Mailing Address - Country:US
Mailing Address - Phone:404-641-0010
Mailing Address - Fax:
Practice Address - Street 1:8725 ROSWELL RD STE G
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-7500
Practice Address - Country:US
Practice Address - Phone:770-640-5956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist