Individual
MANDANA GHODRAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
214 E 23RD ST, CHEYENNE, WY 82001-3748
(404) 316-2505
Mailing address
214 E 23RD ST, CHEYENNE, WY 82001-3748
(307) 996-1512
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3610
WY
Other
Enumeration date
07/01/2018
Last updated
07/01/2018
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