Provider Demographics
NPI:1881978674
Name:AMIRI, FATEMEH PARISA (PHARMD)
Entity type:Individual
Prefix:
First Name:FATEMEH
Middle Name:PARISA
Last Name:AMIRI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 CASTLETON TER
Mailing Address - Street 2:APT C
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-7921
Mailing Address - Country:US
Mailing Address - Phone:408-245-4443
Mailing Address - Fax:
Practice Address - Street 1:643 SANTA CRUZ AVE
Practice Address - Street 2:643 SANTA CRUZ AVE
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4502
Practice Address - Country:US
Practice Address - Phone:650-321-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427063718Medicare UPIN