Provider Demographics
NPI:1790084754
Name:EMAMJOMEH, FOROZAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:FOROZAN
Middle Name:
Last Name:EMAMJOMEH
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 1:761 PIERREMONT RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2211
Mailing Address - Country:US
Mailing Address - Phone:318-861-3311
Mailing Address - Fax:318-866-2642
Practice Address - Street 1:761 PIERREMONT RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2211
Practice Address - Country:US
Practice Address - Phone:318-861-3311
Practice Address - Fax:318-866-2642
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16726183500000X
OH03120484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist