Provider Demographics
NPI:1598168007
Name:SHAMLOO, SHAHRZAD (RPH)
Entity Type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:SHAMLOO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 RETAIL WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-6476
Mailing Address - Country:US
Mailing Address - Phone:919-496-4644
Mailing Address - Fax:
Practice Address - Street 1:705 RETAIL WAY
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-6476
Practice Address - Country:US
Practice Address - Phone:919-496-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist