Provider Demographics
NPI:1770836710
Name:TAHERKHANI, LEILA (RPH)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:TAHERKHANI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 N 12TH ST APT 1026
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-7709
Mailing Address - Country:US
Mailing Address - Phone:602-550-4132
Mailing Address - Fax:
Practice Address - Street 1:18420 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-1361
Practice Address - Country:US
Practice Address - Phone:602-993-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist