Provider Demographics
NPI:1760159610
Name:ESLAMI, SHAFAGH
Entity Type:Individual
Prefix:
First Name:SHAFAGH
Middle Name:
Last Name:ESLAMI
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 1:99 VISTA MONTANA APT 4626
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2364
Mailing Address - Country:US
Mailing Address - Phone:865-766-7003
Mailing Address - Fax:
Practice Address - Street 1:99 VISTA MONTANA APT 4626
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2364
Practice Address - Country:US
Practice Address - Phone:865-766-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH84871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist