Provider Demographics
NPI:1609151703
Name:BASTANI, NAZANIN F (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NAZANIN
Middle Name:F
Last Name:BASTANI
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 1:7490 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1067
Mailing Address - Country:US
Mailing Address - Phone:248-661-4409
Mailing Address - Fax:248-661-4428
Practice Address - Street 1:7490 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1067
Practice Address - Country:US
Practice Address - Phone:248-661-4409
Practice Address - Fax:248-661-4428
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist