Provider Demographics
NPI:1023505260
Name:MOSHFEGHI, MERSEDEH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MERSEDEH
Middle Name:
Last Name:MOSHFEGHI
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 1:18320 HEATHERLEA DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4085
Mailing Address - Country:US
Mailing Address - Phone:734-469-9600
Mailing Address - Fax:
Practice Address - Street 1:18320 HEATHERLEA DR
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4085
Practice Address - Country:US
Practice Address - Phone:734-469-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist