Provider Demographics
NPI:1316494024
Name:NADERI, MANDANA (PHARMD, MPH, BCIDP)
Entity type:Individual
Prefix:DR
First Name:MANDANA
Middle Name:
Last Name:NADERI
Suffix:
Gender:F
Credentials:PHARMD, MPH, BCIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 LINGERING PINE DR NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5661
Mailing Address - Country:US
Mailing Address - Phone:425-577-8267
Mailing Address - Fax:
Practice Address - Street 1:650 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2222
Practice Address - Country:US
Practice Address - Phone:602-827-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist