Provider Demographics
NPI:1861025470
Name:ALAVI, MEHRDAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:ALAVI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 NE ROMANE PL APT 5305
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6072
Mailing Address - Country:US
Mailing Address - Phone:818-359-1582
Mailing Address - Fax:
Practice Address - Street 1:19133 WILLAMETTE DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-2019
Practice Address - Country:US
Practice Address - Phone:503-303-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60974495183500000X
ORRPH-0017111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist