Provider Demographics
NPI:1396101630
Name:AGHAEIPOUR, MARJAN (PHARM D)
Entity type:Individual
Prefix:
First Name:MARJAN
Middle Name:
Last Name:AGHAEIPOUR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27983 SECO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3872
Mailing Address - Country:US
Mailing Address - Phone:661-296-4127
Mailing Address - Fax:661-296-3648
Practice Address - Street 1:27983 SECO CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3872
Practice Address - Country:US
Practice Address - Phone:661-296-4127
Practice Address - Fax:661-296-3648
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 52681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist