Provider Demographics
NPI:1649453747
Name:KHORRAMI, MAHNAZ M (RPH)
Entity type:Individual
Prefix:MS
First Name:MAHNAZ
Middle Name:M
Last Name:KHORRAMI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7914
Mailing Address - Country:US
Mailing Address - Phone:802-860-0624
Mailing Address - Fax:
Practice Address - Street 1:1024 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-2753
Practice Address - Country:US
Practice Address - Phone:802-865-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033-0003316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist