Provider Demographics
NPI:1659940542
Name:MAHDAVI, FARAH
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:MAHDAVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 N BERYL LN
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-8049
Mailing Address - Country:US
Mailing Address - Phone:267-570-7815
Mailing Address - Fax:
Practice Address - Street 1:2528 BOILING SPRINGS RD STE D
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5361
Practice Address - Country:US
Practice Address - Phone:864-515-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist