Provider Demographics
NPI:1144512401
Name:ZANDIEH VAKILI, AIDA (PHARMD)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:ZANDIEH VAKILI
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 1:170 SAN MATEO RD
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1706
Mailing Address - Country:US
Mailing Address - Phone:650-726-7553
Mailing Address - Fax:
Practice Address - Street 1:170 SAN MATEO RD
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1706
Practice Address - Country:US
Practice Address - Phone:650-726-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist