Provider Demographics
NPI:1013678630
Name:TAYEBALI, HAFIZ (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HAFIZ
Middle Name:
Last Name:TAYEBALI
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 1:2001 ROSEN DR APT 3-304
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-2006
Mailing Address - Country:US
Mailing Address - Phone:919-757-5940
Mailing Address - Fax:
Practice Address - Street 1:105 W TROUTMAN PKWY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3038
Practice Address - Country:US
Practice Address - Phone:970-223-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist