Provider Demographics
NPI:1699553412
Name:FAKHARPOUR, PEYTON (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:FAKHARPOUR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-1199
Mailing Address - Country:US
Mailing Address - Phone:502-962-3710
Mailing Address - Fax:
Practice Address - Street 1:9500 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-1199
Practice Address - Country:US
Practice Address - Phone:502-962-3710
Practice Address - Fax:502-962-3765
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist