Provider Demographics
NPI:1104645563
Name:SHAHVERDIAN, ALEX TATEOS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:TATEOS
Last Name:SHAHVERDIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 HEALTH SCIENCES RD # 4030
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92617-3058
Mailing Address - Country:US
Mailing Address - Phone:949-824-0708
Mailing Address - Fax:
Practice Address - Street 1:856 HEALTH SCIENCES RD # 4030
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617-3058
Practice Address - Country:US
Practice Address - Phone:949-824-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist