Provider Demographics
NPI:1730662099
Name:AGAHI, ROYA
Entity Type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:AGAHI
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 1:26391 LA TRAVIATA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-6518
Mailing Address - Country:US
Mailing Address - Phone:949-800-9555
Mailing Address - Fax:
Practice Address - Street 1:8465 N STAR WAY
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-3808
Practice Address - Country:US
Practice Address - Phone:916-534-9831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist