Provider Demographics
NPI:1669159430
Name:SERAJI, MAHNAZ (RPH)
Entity type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:
Last Name:SERAJI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MAHNAZ
Other - Middle Name:
Other - Last Name:SERAJI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:4974 S VALENE STREENT
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117
Mailing Address - Country:US
Mailing Address - Phone:801-467-0152
Mailing Address - Fax:801-467-7729
Practice Address - Street 1:3250 S 700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1641
Practice Address - Country:US
Practice Address - Phone:801-467-0152
Practice Address - Fax:801-467-7729
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2701792311885581183500000X
UT270179231188581894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist