Provider Demographics
NPI:1982114377
Name:GOLMIRZAIE, PEGAH (PHARM D)
Entity Type:Individual
Prefix:
First Name:PEGAH
Middle Name:
Last Name:GOLMIRZAIE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EXETER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2636
Mailing Address - Country:US
Mailing Address - Phone:479-236-2244
Mailing Address - Fax:
Practice Address - Street 1:12 EXETER
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2636
Practice Address - Country:US
Practice Address - Phone:479-236-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist