Provider Demographics
NPI:1699178921
Name:HOSSEINPOUR, ABOLFAZL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ABOLFAZL
Middle Name:
Last Name:HOSSEINPOUR
Suffix:
Gender:M
Credentials:PHARMACIST
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 67
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-0067
Mailing Address - Country:US
Mailing Address - Phone:775-945-3045
Mailing Address - Fax:775-945-1829
Practice Address - Street 1:95 ARMORY
Practice Address - Street 2:HIGHWAY 95 AND ARMORY , SAFE WAY PHARMACY
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-0067
Practice Address - Country:US
Practice Address - Phone:775-945-3045
Practice Address - Fax:775-945-1829
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist