Provider Demographics
NPI:1891987277
Name:NAZARI, AZAR
Entity Type:Individual
Prefix:
First Name:AZAR
Middle Name:
Last Name:NAZARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MASOUMEH
Other - Middle Name:
Other - Last Name:NAZARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:539 S MORNINGSTAR DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1625
Mailing Address - Country:US
Mailing Address - Phone:714-685-1563
Mailing Address - Fax:
Practice Address - Street 1:539 S MORNINGSTAR DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1625
Practice Address - Country:US
Practice Address - Phone:714-685-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist