Provider Demographics
NPI:1447623640
Name:MOHEMPOUR, ALA
Entity type:Individual
Prefix:
First Name:ALA
Middle Name:
Last Name:MOHEMPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 TREAT BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2704
Mailing Address - Country:US
Mailing Address - Phone:925-676-4040
Mailing Address - Fax:925-676-0650
Practice Address - Street 1:4424 TREAT BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2704
Practice Address - Country:US
Practice Address - Phone:925-676-4040
Practice Address - Fax:925-676-0650
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist