Provider Demographics
NPI:1134739576
Name:ALI, SHAYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:ALI
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 1:24415 BEAR MTN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7252
Mailing Address - Country:US
Mailing Address - Phone:210-577-0310
Mailing Address - Fax:
Practice Address - Street 1:302 VALLEY HI DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-4602
Practice Address - Country:US
Practice Address - Phone:210-673-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist