Provider Demographics
NPI:1891573432
Name:GHADERI MASIHI, VANO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VANO
Middle Name:
Last Name:GHADERI MASIHI
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 1:14238 N 26TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5955
Mailing Address - Country:US
Mailing Address - Phone:602-432-2605
Mailing Address - Fax:
Practice Address - Street 1:6601 W BETHANY HOME RD STE A10
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-4946
Practice Address - Country:US
Practice Address - Phone:623-440-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist