Provider Demographics
NPI:1265742605
Name:TAHERI, SHAHIN (RPH)
Entity type:Individual
Prefix:
First Name:SHAHIN
Middle Name:
Last Name:TAHERI
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 1:15222 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:91784
Mailing Address - Country:US
Mailing Address - Phone:909-803-2632
Mailing Address - Fax:
Practice Address - Street 1:15222 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:91784
Practice Address - Country:US
Practice Address - Phone:909-803-2632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist