Provider Demographics
NPI:1548853195
Name:DASTOORI, ROSANNA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROSANNA
Middle Name:
Last Name:DASTOORI
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 1:620 KEED AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6216
Mailing Address - Country:US
Mailing Address - Phone:661-492-6984
Mailing Address - Fax:
Practice Address - Street 1:904 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4802
Practice Address - Country:US
Practice Address - Phone:225-665-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist