Provider Demographics
NPI:1003615261
Name:GHADERI MASIHI, SASON
Entity type:Individual
Prefix:
First Name:SASON
Middle Name:
Last Name:GHADERI MASIHI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7183 W HEDGE HOG PL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-6407
Mailing Address - Country:US
Mailing Address - Phone:602-317-0766
Mailing Address - Fax:
Practice Address - Street 1:1101 N CENTRAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1829
Practice Address - Country:US
Practice Address - Phone:602-257-1133
Practice Address - Fax:602-257-1134
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist