Provider Demographics
NPI:1710579941
Name:BORASHAN, KELAYDIN HORMOZI
Entity Type:Individual
Prefix:DR
First Name:KELAYDIN
Middle Name:HORMOZI
Last Name:BORASHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2887 UTICA CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5170
Mailing Address - Country:US
Mailing Address - Phone:702-373-5515
Mailing Address - Fax:
Practice Address - Street 1:4490 PARADISE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-6573
Practice Address - Country:US
Practice Address - Phone:702-696-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist