Provider Demographics
NPI:1700764651
Name:PRASTHOFER, NOOSHIN H (RPH)
Entity type:Individual
Prefix:
First Name:NOOSHIN
Middle Name:H
Last Name:PRASTHOFER
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:PO BOX 91044
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1044
Mailing Address - Country:US
Mailing Address - Phone:801-708-1175
Mailing Address - Fax:
Practice Address - Street 1:6306 S AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5601
Practice Address - Country:US
Practice Address - Phone:801-432-5300
Practice Address - Fax:801-708-1175
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9801266-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist