Provider Demographics
NPI:1215666425
Name:NIKOUNEJAD, FARHAD
Entity type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:NIKOUNEJAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 ELENA WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7871
Mailing Address - Country:US
Mailing Address - Phone:404-512-2862
Mailing Address - Fax:
Practice Address - Street 1:4025 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3013
Practice Address - Country:US
Practice Address - Phone:770-710-0478
Practice Address - Fax:770-710-0861
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist