Provider Demographics
NPI:1205963725
Name:SHANEHSAZ, HOOSHANG (RPH)
Entity type:Individual
Prefix:DR
First Name:HOOSHANG
Middle Name:
Last Name:SHANEHSAZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 NAULT RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-5808
Mailing Address - Country:US
Mailing Address - Phone:302-734-9707
Mailing Address - Fax:302-223-1090
Practice Address - Street 1:100 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1752
Practice Address - Country:US
Practice Address - Phone:302-223-1370
Practice Address - Fax:302-223-1090
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-00021271835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy