Provider Demographics
NPI:1912678822
Name:SAADAT MOGHADDAM, MORVARID (RPH)
Entity Type:Individual
Prefix:DR
First Name:MORVARID
Middle Name:
Last Name:SAADAT MOGHADDAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 NE 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-8757
Mailing Address - Country:US
Mailing Address - Phone:360-719-9686
Mailing Address - Fax:
Practice Address - Street 1:3307 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2062
Practice Address - Country:US
Practice Address - Phone:360-335-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61184814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist