Provider Demographics
NPI:1487129938
Name:DARI, GHADEH (PHARM D)
Entity type:Individual
Prefix:
First Name:GHADEH
Middle Name:
Last Name:DARI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4289 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9536
Mailing Address - Country:US
Mailing Address - Phone:734-330-5730
Mailing Address - Fax:
Practice Address - Street 1:4289 SHETLAND DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9536
Practice Address - Country:US
Practice Address - Phone:734-330-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist