Provider Demographics
NPI:1295306512
Name:MASHAYEKAN, AHMAD (RPH)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:MASHAYEKAN
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 1:9850 GENESEE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1226
Mailing Address - Country:US
Mailing Address - Phone:858-622-1800
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE STE 160
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1226
Practice Address - Country:US
Practice Address - Phone:858-622-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist