Provider Demographics
NPI:1821649047
Name:FOROUGHI, SAHBA
Entity Type:Individual
Prefix:
First Name:SAHBA
Middle Name:
Last Name:FOROUGHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 E SEVEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5548
Mailing Address - Country:US
Mailing Address - Phone:801-897-7904
Mailing Address - Fax:
Practice Address - Street 1:212 E 12300 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8184
Practice Address - Country:US
Practice Address - Phone:801-571-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT260883-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist