Provider Demographics
NPI:1316437817
Name:SHAHOSSEINI, ALI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:SHAHOSSEINI
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 1:4424 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1312
Mailing Address - Country:US
Mailing Address - Phone:615-883-9520
Mailing Address - Fax:615-883-3598
Practice Address - Street 1:4424 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1312
Practice Address - Country:US
Practice Address - Phone:615-883-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000033921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist