Provider Demographics
NPI:1558641134
Name:MOHSENI, FARANAK R
Entity Type:Individual
Prefix:
First Name:FARANAK
Middle Name:R
Last Name:MOHSENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 S COOPER RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7160
Mailing Address - Country:US
Mailing Address - Phone:480-497-5434
Mailing Address - Fax:480-503-2063
Practice Address - Street 1:785 S COOPER RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85233-7160
Practice Address - Country:US
Practice Address - Phone:480-497-5434
Practice Address - Fax:480-503-2063
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist