Provider Demographics
NPI:1508079021
Name:KIANI, SHAHNAZ
Entity Type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:KIANI
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 1:1077 GRAY FOX CIR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6969
Mailing Address - Country:US
Mailing Address - Phone:925-462-6537
Mailing Address - Fax:
Practice Address - Street 1:1077 GRAY FOX CIR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6969
Practice Address - Country:US
Practice Address - Phone:925-462-6537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40749183500000X
CA8481835G0303X
CA52041835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy