Provider Demographics
NPI:1982096012
Name:MOHTASHAMI, SARVENAZ (PHARMACIST (PHARMD))
Entity type:Individual
Prefix:
First Name:SARVENAZ
Middle Name:
Last Name:MOHTASHAMI
Suffix:
Gender:F
Credentials:PHARMACIST (PHARMD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 NE AMBASSADOR PL
Mailing Address - Street 2:STE. 103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-1394
Mailing Address - Country:US
Mailing Address - Phone:503-399-8148
Mailing Address - Fax:
Practice Address - Street 1:7700 NE AMBASSADOR PL
Practice Address - Street 2:STE. 103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-1394
Practice Address - Country:US
Practice Address - Phone:503-399-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist