Provider Demographics
NPI:1295504124
Name:MOSTAFAEI, GHAZALEH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GHAZALEH
Middle Name:
Last Name:MOSTAFAEI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 DISTRICT AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2784
Mailing Address - Country:US
Mailing Address - Phone:434-328-7033
Mailing Address - Fax:
Practice Address - Street 1:3171 DISTRICT AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2784
Practice Address - Country:US
Practice Address - Phone:434-328-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0135164183500000X
VA0202221722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist