Provider Demographics
NPI:1508201567
Name:ABOLHASSANI, MARIAM (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:MARIAM
Middle Name:
Last Name:ABOLHASSANI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31731 CAPUCHINA WAY
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3615
Mailing Address - Country:US
Mailing Address - Phone:949-636-5306
Mailing Address - Fax:
Practice Address - Street 1:31731 CAPUCHINA WAY
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3615
Practice Address - Country:US
Practice Address - Phone:949-636-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-05
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist