Provider Demographics
NPI:1659794592
Name:ZIA-EBRAHMI, SOODABEH (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOODABEH
Middle Name:
Last Name:ZIA-EBRAHMI
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 1:1082 SR 28
Mailing Address - Street 2:MEIJER PHARMACY
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150
Mailing Address - Country:US
Mailing Address - Phone:513-576-5510
Mailing Address - Fax:
Practice Address - Street 1:1082 SR 28
Practice Address - Street 2:MEIJER PHARMACY,
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150
Practice Address - Country:US
Practice Address - Phone:513-576-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist