Provider Demographics
NPI:1124315767
Name:HAFEZIZADEH, SHEENA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHEENA
Middle Name:LYNN
Last Name:HAFEZIZADEH
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 1:8148 E SANTA ANA CANYON RD
Mailing Address - Street 2:T-0677
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1105
Mailing Address - Country:US
Mailing Address - Phone:714-921-2376
Mailing Address - Fax:714-921-2376
Practice Address - Street 1:8148 E SANTA ANA CANYON RD
Practice Address - Street 2:T-0677
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1105
Practice Address - Country:US
Practice Address - Phone:714-921-2376
Practice Address - Fax:714-921-2376
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist