Provider Demographics
NPI:1780192849
Name:FARSA, PARISA (PHARM D)
Entity Type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:FARSA
Suffix:
Gender:F
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 1:1022 SKY JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5076
Mailing Address - Country:US
Mailing Address - Phone:925-683-3751
Mailing Address - Fax:925-683-9208
Practice Address - Street 1:9100 ALCOSTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3857
Practice Address - Country:US
Practice Address - Phone:925-364-9217
Practice Address - Fax:925-364-9208
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55679OtherCALIFORNIA BOP