Provider Demographics
NPI:1336451186
Name:GOUDARZI, RAMIN (PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:GOUDARZI
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 SAN MATEO RD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1706
Mailing Address - Country:US
Mailing Address - Phone:408-316-6660
Mailing Address - Fax:
Practice Address - Street 1:170 SAN MATEO RD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1706
Practice Address - Country:US
Practice Address - Phone:650-726-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14320183500000X
CA50699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist