Provider Demographics
NPI:1578574513
Name:HAJIKHALILI, ARDALAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ARDALAN
Middle Name:
Last Name:HAJIKHALILI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:EDDIE
Other - Middle Name:HAJI
Other - Last Name:KHALILI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6025 BLACKWATER TRL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2714
Mailing Address - Country:US
Mailing Address - Phone:404-642-9822
Mailing Address - Fax:770-394-1773
Practice Address - Street 1:1000 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist