Provider Demographics
NPI:1124464763
Name:NOUHAVANDI, JESSICA SAHAR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SAHAR
Last Name:NOUHAVANDI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 PATRIOT DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3407
Mailing Address - Country:US
Mailing Address - Phone:805-523-8300
Mailing Address - Fax:805-523-8333
Practice Address - Street 1:865 PATRIOT DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3407
Practice Address - Country:US
Practice Address - Phone:805-523-8300
Practice Address - Fax:805-523-8333
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist