Panteha Mortazavi, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH029520 Issued in GA

Practice address

1871 Chamblee Tucker Rd
Chamblee, GA 30341-2737

Phone

(770) 455-4699

Fax

(770) 455-0744

NPI assigned

Nov 4, 2020

Sex

Female

Sole proprietor

No

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Chamblee, GA
  • NPI 1659436863
  NPD (past)
• Wal-Mart Stores East, LP

  • Pharmacy
  • Apollo Beach, FL
  • NPI 1437027208
  NPD (past)

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

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1992306039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1871 CHAMBLEE TUCKER RD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "303412737",
            "telephone_number": "770-455-4699",
            "fax_number": "770-455-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1871 CHAMBLEE TUCKER RD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "303412737",
            "telephone_number": "770-455-4699",
            "fax_number": "770-455-0744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTAZAVI",
        "first_name": "PANTEHA",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-04",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH029520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• MKD Enterprises, Inc.
• Adolfo Felix Molina, M.D.
• Razin Momin
• Sunhye Moon
• June Powell Moree, APRN, BC
• Ashley Mosley, MS
• Keenon Myers, DPT
• Tracy Nailor, MD, MPH
• Nisy Narayana Jaya
• Larriette Abaida Narh, NP-C

• Pharmacist in Chamblee, GA
• Providers in Chamblee, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.