Mirzaali Vagaslo Mehdizadeh, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

41673 Issued in TX

Practice address

502 N Valley Pkwy # 1a
Lewisville, TX 75067-3437

Phone

(469) 949-1003

Fax

(469) 949-1004

NPI assigned

Oct 2, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1013514074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CRYSTAL CT",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750813543",
            "telephone_number": "469-471-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 N VALLEY PKWY # 1A",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750673437",
            "telephone_number": "469-949-1003",
            "fax_number": "469-949-1004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4090 Mapleshade Ln",
            "address_purpose": "LOCATION",
            "city": "Plano",
            "state": "TX",
            "postal_code": "750930024",
            "country_code": "US",
            "telephone_number": "469-649-7007",
            "fax_number": "469-649-7008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEHDIZADEH",
        "first_name": "MIRZAALI",
        "middle_name": "VAGASLO",
        "name_prefix": "Mr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-02",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "41673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Lewisville, TX
• Providers in Lewisville, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.