Provider Demographics
NPI:1760123129
Name:FOROUGHIAN, BEHRANG KIAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:BEHRANG
Middle Name:KIAN
Last Name:FOROUGHIAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4802
Mailing Address - Country:US
Mailing Address - Phone:225-644-0434
Mailing Address - Fax:
Practice Address - Street 1:234 HIGHLAND TRACE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-5058
Practice Address - Country:US
Practice Address - Phone:225-810-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1760123129Medicaid