Provider Demographics
NPI:1801268511
Name:GHAFOORI, FARIBORZ (PHARMD)
Entity type:Individual
Prefix:
First Name:FARIBORZ
Middle Name:
Last Name:GHAFOORI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 E HAMPTON AVE APT 1181
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6603
Mailing Address - Country:US
Mailing Address - Phone:559-916-4880
Mailing Address - Fax:
Practice Address - Street 1:1212 S GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2792
Practice Address - Country:US
Practice Address - Phone:559-916-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021451183500000X
GARPH027529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist