Provider Demographics
NPI:1023423282
Name:RAFIEI, AMIR
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:RAFIEI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 E TIMPIE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5972
Mailing Address - Country:US
Mailing Address - Phone:801-688-0937
Mailing Address - Fax:
Practice Address - Street 1:1016 E TIMPIE DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5972
Practice Address - Country:US
Practice Address - Phone:801-688-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT71145171701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist