Provider Demographics
NPI:1740863950
Name:GANJINEH, SOGOL (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:SOGOL
Middle Name:
Last Name:GANJINEH
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31890 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3756
Mailing Address - Country:US
Mailing Address - Phone:949-248-3318
Mailing Address - Fax:949-248-5220
Practice Address - Street 1:31890 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3756
Practice Address - Country:US
Practice Address - Phone:949-248-3318
Practice Address - Fax:949-248-5220
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62041183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician