Provider Demographics
NPI:1720681224
Name:MESGAR, AMIR B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:B
Last Name:MESGAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AMIR
Other - Middle Name:B
Other - Last Name:MESGAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4609 REMINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3049
Mailing Address - Country:US
Mailing Address - Phone:817-683-8953
Mailing Address - Fax:
Practice Address - Street 1:3701 IRA E WOODS AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4213
Practice Address - Country:US
Practice Address - Phone:817-251-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist