Provider Demographics
NPI:1487202719
Name:MOZAFFAR, AYSHA RAZA (RPH)
Entity type:Individual
Prefix:
First Name:AYSHA
Middle Name:RAZA
Last Name:MOZAFFAR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 MISTY WOODS LANE
Mailing Address - Street 2:ADDRESS (CONT'D)
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-1428
Mailing Address - Country:US
Mailing Address - Phone:317-407-8513
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1428
Practice Address - Country:US
Practice Address - Phone:317-882-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018989A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist