Provider Demographics
NPI:1588940548
Name:ESMAEILLOO, BITA (RPH)
Entity type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:ESMAEILLOO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 N POWER RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1681
Mailing Address - Country:US
Mailing Address - Phone:480-396-3838
Mailing Address - Fax:480-641-2961
Practice Address - Street 1:2727 N POWER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1681
Practice Address - Country:US
Practice Address - Phone:480-396-3838
Practice Address - Fax:480-641-2961
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist