Provider Demographics
NPI:1427316173
Name:NADERPOUR, MANOUCHEHR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MANOUCHEHR
Middle Name:
Last Name:NADERPOUR
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:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:PAINTER
Mailing Address - State:VA
Mailing Address - Zip Code:23420-0244
Mailing Address - Country:US
Mailing Address - Phone:540-797-5247
Mailing Address - Fax:
Practice Address - Street 1:25096 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:ONLEY
Practice Address - State:VA
Practice Address - Zip Code:23418
Practice Address - Country:US
Practice Address - Phone:757-787-7154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist