Provider Demographics
NPI:1194063289
Name:KHADAVI, SHERRY (PHARMD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:KHADAVI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:BRAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3311 DONA MARIA DR
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4263
Mailing Address - Country:US
Mailing Address - Phone:310-924-8366
Mailing Address - Fax:
Practice Address - Street 1:3311 DONA MARIA DR
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-4263
Practice Address - Country:US
Practice Address - Phone:310-924-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist