Provider Demographics
NPI:1699498550
Name:HOSSEINI, RAHA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RAHA
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CELEBRATION CV APT 1407
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-6233
Mailing Address - Country:US
Mailing Address - Phone:318-791-2877
Mailing Address - Fax:
Practice Address - Street 1:510 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-4444
Practice Address - Country:US
Practice Address - Phone:318-424-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist