Provider Demographics
NPI:1154908572
Name:ROUHANI, MOJDEH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOJDEH
Middle Name:
Last Name:ROUHANI
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 1:19950 RINALDI ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4141
Mailing Address - Country:US
Mailing Address - Phone:818-360-1915
Mailing Address - Fax:818-367-4987
Practice Address - Street 1:19950 RINALDI ST STE 102
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4141
Practice Address - Country:US
Practice Address - Phone:818-360-1915
Practice Address - Fax:818-368-4987
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48684Other1538350541