Provider Demographics
NPI:1629232400
Name:YOUSEFI, MEHDI M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:M
Last Name:YOUSEFI
Suffix:
Gender:M
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:PO BOX 18972
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96151-8972
Mailing Address - Country:US
Mailing Address - Phone:530-541-0755
Mailing Address - Fax:
Practice Address - Street 1:1040 MARJORIE STREET
Practice Address - Street 2:6
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8972
Practice Address - Country:US
Practice Address - Phone:530-541-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist