Provider Demographics
NPI:1972800662
Name:AHMADIAN, ALIREZA (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:AHMADIAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14631 S GARNETT ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8411
Mailing Address - Country:US
Mailing Address - Phone:913-206-3854
Mailing Address - Fax:
Practice Address - Street 1:14631 S GARNETT ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-8411
Practice Address - Country:US
Practice Address - Phone:913-206-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-121901835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist