Provider Demographics
NPI:1427333210
Name:MAHINFALAH, ARDALAN (PHARM D)
Entity type:Individual
Prefix:
First Name:ARDALAN
Middle Name:
Last Name:MAHINFALAH
Suffix:
Gender:M
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 1:4296 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2805
Mailing Address - Country:US
Mailing Address - Phone:414-321-7602
Mailing Address - Fax:414-321-1409
Practice Address - Street 1:4296 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-2805
Practice Address - Country:US
Practice Address - Phone:414-321-7602
Practice Address - Fax:414-321-1409
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15620-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist