Provider Demographics
NPI:1720680630
Name:ASADOLLAHI, AMIR K (RPH)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:K
Last Name:ASADOLLAHI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26973 NEWPORT RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-9221
Mailing Address - Country:US
Mailing Address - Phone:951-301-6356
Mailing Address - Fax:
Practice Address - Street 1:26973 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-9221
Practice Address - Country:US
Practice Address - Phone:951-301-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist