Provider Demographics
NPI:1891018438
Name:EGHRARI, SHAHIN
Entity Type:Individual
Prefix:
First Name:SHAHIN
Middle Name:
Last Name:EGHRARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DUNWOODY PARK STE 102
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6710
Mailing Address - Country:US
Mailing Address - Phone:678-441-0045
Mailing Address - Fax:678-441-0079
Practice Address - Street 1:5 DUNWOODY PARK STE 102
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6710
Practice Address - Country:US
Practice Address - Phone:678-441-0045
Practice Address - Fax:678-441-0079
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016077183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric