Provider Demographics
NPI:1861646614
Name:NIKSERESHT, MASOODE S (R PH)
Entity Type:Individual
Prefix:MR
First Name:MASOODE
Middle Name:S
Last Name:NIKSERESHT
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SENATE AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-1283
Mailing Address - Country:US
Mailing Address - Phone:712-623-1900
Mailing Address - Fax:712-623-5245
Practice Address - Street 1:600 SENATE AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1283
Practice Address - Country:US
Practice Address - Phone:712-623-1900
Practice Address - Fax:712-623-5245
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist