Provider Demographics
NPI:1649876194
Name:KHAVARI, SHEEDA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:SHEEDA
Middle Name:
Last Name:KHAVARI
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 1:2662 W LUCAS RD
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:TX
Mailing Address - Zip Code:75002-7513
Mailing Address - Country:US
Mailing Address - Phone:469-675-8110
Mailing Address - Fax:
Practice Address - Street 1:2662 W LUCAS RD
Practice Address - Street 2:
Practice Address - City:LUCAS
Practice Address - State:TX
Practice Address - Zip Code:75002-7513
Practice Address - Country:US
Practice Address - Phone:469-675-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist