Provider Demographics
NPI:1891877866
Name:AZERANG, MAHIN (RPH)
Entity Type:Individual
Prefix:MS
First Name:MAHIN
Middle Name:
Last Name:AZERANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 COUNTRY CLUB GATE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950
Mailing Address - Country:US
Mailing Address - Phone:831-883-5200
Mailing Address - Fax:
Practice Address - Street 1:3401 ENGINEER LN
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-7200
Practice Address - Country:US
Practice Address - Phone:831-883-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist