Provider Demographics
NPI:1811405723
Name:CHITSAZ, FERESHTEH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:FERESHTEH
Middle Name:
Last Name:CHITSAZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25952 MAJORCA WAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5275
Mailing Address - Country:US
Mailing Address - Phone:949-395-5724
Mailing Address - Fax:
Practice Address - Street 1:25952 MAJORCA WAY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5275
Practice Address - Country:US
Practice Address - Phone:949-395-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist