Provider Demographics
NPI:1801556410
Name:KHAFAJI ZAD, MAHNAZ
Entity type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:
Last Name:KHAFAJI ZAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 GARLAND ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-2819
Mailing Address - Country:US
Mailing Address - Phone:402-304-1786
Mailing Address - Fax:
Practice Address - Street 1:4920 GARLAND ST APT 4
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-2819
Practice Address - Country:US
Practice Address - Phone:402-304-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician