Provider Demographics
NPI:1548858392
Name:SHOKROLLAH SHIRAZI, ARYAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ARYAN
Middle Name:
Last Name:SHOKROLLAH SHIRAZI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WATERMAN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1654
Mailing Address - Country:US
Mailing Address - Phone:949-562-5081
Mailing Address - Fax:
Practice Address - Street 1:15180 KENSINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1801
Practice Address - Country:US
Practice Address - Phone:714-259-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist