Provider Demographics
NPI:1811381635
Name:SARAIE, SHAHRZAD (RPH)
Entity Type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:SARAIE
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 1:1 WELWYN RD # 273
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3527
Mailing Address - Country:US
Mailing Address - Phone:818-000-0000
Mailing Address - Fax:
Practice Address - Street 1:12842 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2369
Practice Address - Country:US
Practice Address - Phone:818-818-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist