Provider Demographics
NPI:1295023356
Name:SOBHANIPOUR, SHIRIN
Entity type:Individual
Prefix:MS
First Name:SHIRIN
Middle Name:
Last Name:SOBHANIPOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 CAMINO ARROYO
Mailing Address - Street 2:T1851
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-848-6941
Mailing Address - Fax:
Practice Address - Street 1:6705 CAMINO ARROYO
Practice Address - Street 2:T-1851
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7075
Practice Address - Country:US
Practice Address - Phone:408-848-6941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist