Provider Demographics
NPI:1851995211
Name:MOHEBBAN, AMIRREZA (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMIRREZA
Middle Name:
Last Name:MOHEBBAN
Suffix:
Gender:M
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 1:795 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-4227
Mailing Address - Country:US
Mailing Address - Phone:409-735-2469
Mailing Address - Fax:409-735-9736
Practice Address - Street 1:795 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-4227
Practice Address - Country:US
Practice Address - Phone:409-735-2469
Practice Address - Fax:409-735-9736
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist