Provider Demographics
NPI:1568993129
Name:HOSSEINI, NIMA (PHARMD,RPH)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 STATE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2137
Mailing Address - Country:US
Mailing Address - Phone:626-390-4728
Mailing Address - Fax:
Practice Address - Street 1:1724 STATE ST APT 2
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2137
Practice Address - Country:US
Practice Address - Phone:626-390-4728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist