Provider Demographics
NPI:1518243484
Name:AZARI, MINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:AZARI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 LYNDHURST ST APT 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-1912
Mailing Address - Country:US
Mailing Address - Phone:512-788-0133
Mailing Address - Fax:
Practice Address - Street 1:10600 W PARMER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4627
Practice Address - Country:US
Practice Address - Phone:512-238-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist