Provider Demographics
NPI:1215525720
Name:SHABBOUI, PAYAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:SHABBOUI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8536 WILSHIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3154
Mailing Address - Country:US
Mailing Address - Phone:310-657-4090
Mailing Address - Fax:
Practice Address - Street 1:8536 WILSHIRE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3154
Practice Address - Country:US
Practice Address - Phone:310-657-4090
Practice Address - Fax:310-657-4790
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5634729OtherNCPDP