Provider Demographics
NPI:1245904796
Name:MOGHTADERI-ESFAHANI, SAREH (RPH)
Entity type:Individual
Prefix:
First Name:SAREH
Middle Name:
Last Name:MOGHTADERI-ESFAHANI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:SAREH
Other - Middle Name:
Other - Last Name:MOGHTADERI-ESFAHANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13800 HIGHWAY 9 N STE E
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4590
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13800 HIGHWAY 9 N STE E
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4590
Practice Address - Country:US
Practice Address - Phone:770-608-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist